Study questions use of addictive opioids
for long-term treatment of back pain
Narcotic drugs (opioids) are commonly prescribed for short-term relief of chronic back pain, but their effectiveness long-term has been questioned in a review article by researchers at the School of Medicine, who also found that behavior consistent with opioid abuse was reported in 24% of cases.
"Patients with chronic back pain commonly request pain medication, and opioid medications are used despite the concerns clinicians have with patients developing an addiction to these medications," says first author Dr. Bridget Martell, assistant clinical professor of general internal medicine at the School of Medicine. "Our findings suggest that clinicians should consider other treatments with similar benefits but fewer long-term adverse effects." The study was published in the Jan. 16 Annals of Internal Medicine.
Martell and co-authors conducted a systematic literature review and meta-analysis that addressed the prevalence and effectiveness of opioid prescriptions for patients with chronic back pain, and the incidence of substance abuse disorders among patients receiving opioid medications for chronic back pain.
The study populations consisted of non-obstetric patients over age 18 with non-malignant chronic back pain lasting for at least three months. The research focused on efficacy of oral, transdermal or topical opioids, where there was no pre-existing diagnosis of opioid dependence.
According to the report, opioids may be effective for the short-term (less than four months) treatment of chronic low back pain, but long-term effectiveness was not conclusive.
"Our results also demonstrate that the quality of the literature on these topics is generally weak and more studies need to be done before firm conclusions can be made," says Martell.
In addition to Martell and corresponding author Dr. David Fiellin, associate professor of general internal medicine at Yale, other authors on the study included Dr. Patrick G. O'Connor, Robert D. Kerns, Dr. William C. Becker, Knashawn H. Morales and Dr. Thomas R. Kosten.
-- By Karen Peart
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