Podcast 878: Opioids for Low Back and Neck Pain

<p dir="ltr"><strong>Contributor: Jared Scott MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <p dir="ltr">Should we use opioids to treat low back and neck pain? The OPAL Trial, published in The Lancet, in June 2023, attempted to answer this very question.</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Objective: Investigate the efficacy and safety of a short course of opioid analgesic (oxycodone-naloxone) for acute low back pain and neck pain.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Trial Design: Triple-blinded, placebo-controlled randomized trial, conducted in Emergency and Primary Care in Sydney, Australia, involving adults with 12 weeks or less of low back or neck pain.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Participants: 347 recruited adults (174 in the opioid group, 173 in the placebo group) with at least moderate pain severity.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Intervention: Participants were assigned to receive either an opioid or a placebo for up to 6 weeks.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Primary Outcome: Pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory (10-point scale).</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Results: No significant difference in pain severity at 6 weeks between the opioid group (mean score 2.78) and placebo group (mean score 2.25).</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Adverse events were reported by 35% in the opioid group and 30% in the placebo group, with more opioid-related adverse events in the opioid group (e.g., constipation).</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Conclusion: Opioids should not be recommended for acute non-specific low back pain or neck pain, as there was no significant difference in pain severity compared with the placebo. T