They were once intended for people who had a lot of pain in the last phase of cancer, for example, but nowadays more than 1 million Dutch people take opioids against the pain. They do not seem to work against back problems. In fact, a placebo is just as effective.
That researchers showed from Erasmus MC and the University of Sydney to 350 people with neck or back pain. It is the first time that scientists are looking at the effect of heavy painkillers. And that turned out to be quite disappointing. Because apart from the fact that the drugs do not help against the pain, people who take them also suffer from all kinds of side effects.
Placebo group better off
The participants were divided into two groups. They took either a placebo or the real drug for six weeks. In addition, they received standard advice to avoid bed rest and to remain active. The subjects were followed for a year.
The findings were not wrong: after six weeks, those who took the heavy painkiller had no less pain than the people who received the placebo. Long-term quality of life and pain levels were even better in the placebo group. And those who received the real drug were slightly more likely to be addicted, even if it was only a small difference.
Last resort
The current guideline is that opioids, such as oxycodone, should only be prescribed as a last resort, when nothing else works. But the researchers argue that the painkillers should never be prescribed again at all. “We have clearly shown that there is no benefit for people with acute back or neck pain. It even causes long-term damage, even after short-term use,” says lead researcher Professor Christine Lin of the University of Sydney.
The findings are not entirely new. Previous research into the effect of opioids on low back pain showed that there was only a very small benefit, while the risk of side effects was high. “Opioids are not as effective as we first thought,” explains Christine Lin Scientias.nl. She says that there are already more studies that have also shown that the heavy painkillers do not work for other forms of pain. “For example, we have shown that opioid drugs are no better for muscle and nerve pain than non-opioids in people who end up in the emergency room. The same applies to people who have been discharged from the hospital after surgery.”
Not penetrated yet
Why do people still take the drugs? “In some cases there is a long waiting list for other treatment methods, which are also more expensive.” Think physiotherapy. “Also, the scientific evidence for the lack of effect of opioids is relatively new and has yet to penetrate clinical practice and the general public. We need to change the perception that both doctors and patients have of opioid drugs.”
Oxycodone is a well-known opioid pain reliever. Photo: HailShadow
Aren’t there forms of pain against which the means can help? “Our research focused on non-cancer pain,” said Lin. “There may be a place for opioids to reduce the pain that cancer causes, in palliative care for example. But an expert in that field can say that better.”
Addiction and side effects
The overuse of heavy painkillers is a problem in almost the entire western world. Addiction and nasty side effects are lurking. Everywhere there is a warning to see the resources as a last resort and to use them only if the benefits outweigh the disadvantages. Professor Chris Maher, who also participated in the study, explains that in recent years the focus has changed from opioid use to other treatment methods such as physical and psychological therapy or milder painkillers such as ibuprofen. “This study provides further evidence that the initial focus should be on more exercise and simple painkillers for back and neck pain.”
Not so innocent
According to the study, long-term quality of life and pain levels were even better in the placebo group. But how much does it matter? “The placebo group had slightly less pain after 1 year than the test group, on average half a point on a 10-point scale where 0 is no pain and 10 is the worst pain imaginable. Although this is a small difference, it is important because it shows that short-term use of opioids (up to six weeks) can have negative long-term consequences,” says Lin. “If you put this result alongside the other findings of the study, which is that opioids have no short-term benefits for pain or other outcomes, it becomes very clear that opioids are not beneficial.”
The use of heavy painkillers is also much less harmless than you may think. “The harmful effects of opioids are well known. They range from mild problems such as constipation or dizziness to serious problems such as addiction, overdose and death,” says Professor McLachlan. “The new study should make it clear that it is really time to phase out the use, as there is limited evidence that the drugs work and there is a known risk of harm.”
Stop it
Lin himself had not expected that opioids would still have negative effects after a long time. “I didn’t think there would be a difference between the opioid and placebo groups in the long run. But the results are clear. Opioids should not be recommended for acute low back and neck pain, even if used for a short time.”
Anyone who reads this and takes the heavy painkillers should not stop doing so at once, warns the researcher. “That can lead to unpleasant withdrawal symptoms. If people have been taking the drugs for a long time, they should be gradually reduced with the help of a doctor.”
2023-07-01 09:02:28
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