Chronic Back Pain: Why Doctors Are Stepping Back from Opioids to Treat It

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Professional guidelines increasingly discourage the use of opioid painkillers as first-line treatment for chronic pain because of the risk of addiction and overdose deaths. On top of that, opioids may be no more effective for common types of chronic musculoskeletal pain than other drugs. This was the finding of a recent clinical trial reported in the Journal of the American Medical Association.

The study involved 240 patients from Veterans Affairs Clinics who had moderate to severe chronic back pain or hip or knee osteoarthritis. Half of the study participants were given opioid drugs (such as morphine, oxycodone, and hydrocodone), the other half received non-opioid drugs (such as acetaminophen, nonsteroidal anti-inflammatory drugs like ibuprofen, certain antidepressants, and topical analgesics); stronger drugs were added when needed. After 12 months, the investigators found no difference in pain-related function or quality of life between the two groups. In fact, pain intensity was reduced slightly more in the non-opioid group.

The results of this and other studies suggest that the long-term use of opioids to treat chronic non-cancer pain (notably back pain or pain from hip or knee arthritis) should be the exception rather than the rule.

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