Millions of people take opioids for chronic back pain, but many of them get limited relief while experiencing side effects and worrying about the stigma associated with taking them, according to research presented at the Anesthesiology 2016 annual meeting (22–26 October, Chicago, USA).
“Patients are increasingly aware that opioids are problematic, but do not know there are alternative treatment options,” said Asokumar Buvanendran, lead author of the study, director of orthopaedic anaesthesia, vice chair for research at Rush University, Chicago, USA, and vice chair of the American Society of Anesthesiologists (ASA) Committee on Pain Medicine. “While some patients may benefit from opioids for severe pain for a few days after an injury, physicians need to wean their patients off them and use multi-modal therapies instead.”
In the study, 2,030 patients with low back pain completed a survey about treatment. Nearly half (n=941) were currently taking opioids. When asked how successful the opioids were at relieving their pain, only 13% said they were “very successful.” The most common answer—given by 44% of patients—was “somewhat successful”, and 31% said “moderately successful.” Twelve per cent replied that the opioids were “not successful.”
Seventy-five per cent said they experienced side effects including constipation (65%), sleepiness (37%), cognitive issues (32%) and opioid dependence (29%).
Respondents also had concerns about the stigma associated with taking opioids. Forty-one per cent said they felt judged by using opioids, while 68% of the patients had also been treated with antidepressants, which only 19% felt a stigma from using.
A major pharmaceutical company recently agreed to disclose in its promotional material that narcotic painkillers carry serious risks of addiction, and agreed not to promote opioids for unapproved, “off-label” uses such as long-term back pain. Researchers also note a lack of solid studies on the effectiveness of opioids in treating back pain beyond 12 weeks.
Patients with chronic low back pain—persistent pain lasting more than three months—should see a pain medicine specialist who uses an approach that combines a variety of treatments that may be more beneficial, said Buvanendran. These treatments include physical therapy, bracing, interventional procedures such as nerve blocks, nerve ablation techniques or implantable devices, other medications such as anti-inflammatories and alternative therapies such as biofeedback and massage, he said.