Authors: Shaheed CA et al., JAMA Intern Med 2016 May 23;
Opioids provided some short- and intermediate-term pain control, but the effect wasn’t clinically meaningful. |
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Patients with chronic low back pain often are treated with opioids, but evidence that these drugs are effective for managing low back pain is lacking. In this systematic review and meta-analysis, investigators examined the results of 20 trials of opioids in 7295 patients with nonspecific chronic low back pain (17 trials were industry-funded). The longest treatment period was 12 weeks.
In 13 studies with results on short-term pain control (<3 months) and 6 studies with intermediate-term results (3–12 months), opioids were associated with improvements of roughly 10 points and 8 points, respectively, on a 100-point scale, compared with placebo — less than the 10- to 20-point change considered to be important. For short-term pain control, higher opioid dosage was associated with better pain relief, but, even at the highest dosage (240 morphine mg equivalents [MMEs] daily), the effect was not clinically meaningful. Disability was evaluated in only three trials, none of which showed any benefit. The proportion of participants who dropped out of the trials because of lack of efficacy or adverse effects ranged from 25% to 80%.
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