Opiates No Solution to Back Pain

In recent times, there has been a continuous flow of reports highlighting the risks associated with opiates, encompassing pain medications like codeine, Percocet, and OxyContin. While the adverse effects of illicit drugs such as heroin on lives and health are well-documented, the emerging concerns revolve around the dangers posed by prescription pain medicines. These medications, prescribed by doctors to address various causes of pain, including musculoskeletal issues like low back pain, have come under scrutiny for their potential risks.

The history of using opiates for chronic pain

Back pain is not a novel issue, but the historical evolution of how doctors have addressed it may be unfamiliar to many. The transformation began with studies revealing inadequate pain management for individuals with advanced cancer. Subsequent research demonstrated that opiate medications enhanced the quality of life for terminally ill patients. Consequently, recommendations emerged for doctors to monitor pain as a vital sign for all patients, treating various types of pain aggressively, including chronic conditions like low back pain. Simultaneously, pharmaceutical companies promoted new formulations of opioid medications with extended duration, facilitating regular use by patients.

However, this paradigm shift in medical practice lacked substantial evidence proving its efficacy in better pain management and reducing its impact on patients’ lives. Previous literature reviews indicated scanty evidence supporting the use of opioids for chronic low back pain, with modest benefits observed in short-term use. The long-term use of these medications was not extensively evaluated, and while short-term studies revealed few risks, longer use has shown increased tolerance, side effects, and the potential for dependence or addiction.

A recent study published in JAMA Internal Medicine, conducted by Dr. Abdel Shaheed and colleagues, further contributes to this understanding. Their updated literature review reinforces the notion that only short-term benefits have been substantiated, with the magnitude of this benefit being modest. Additionally, the study scrutinized the doses of pain medications used in these trials and found that the actual pain relief experienced by individuals was not particularly significant.

Opiates for chronic low back pain carry big risks with uncertain benefits

These recent studies, along with earlier research, highlight that the widespread adoption of opioids for non-cancer pain was premature. The long-term benefits and risks were not well understood, and despite the substantial increase in opioid use, it has not contributed to improved return to previous activity levels or reduced disability rates. What has become evident are the associated risks, including escalating rates of addiction, overdoses, and a surge in deaths linked to prescription opioids. Furthermore, individuals who develop addiction to prescribed pain medications often transition to heroin due to its affordability and accessibility.

However, this does not imply that pain should be left untreated. Many individuals experience genuine, chronic, and disabling pain that requires assistance in management. It also doesn’t imply that every person prescribed opioids will develop an addiction. Nor does it assert that opioid medications have no therapeutic benefits. Nevertheless, it should prompt careful consideration, emphasizing that relying solely on a pill (or multiple pills) does not resolve low back pain and may lead to a multitude of complications.

What you can do for back pain

Fortunately, there is increasing evidence supporting treatments for chronic low-back pain that don’t rely on pills, injections, or surgery. Instead, the focus should be on getting individuals with back pain active again and teaching them to manage the pain rather than seeking a cure. Various therapies, including exercise, education about back care, yoga, and mind-body techniques, have demonstrated effectiveness in controlling back pain.

For patients with chronic back pain not currently using opioids, it’s advisable to avoid them. For those already using opioids, a sudden cessation is not recommended, as the body has adapted to these medications. With proper assistance, individuals taking opioid pain relievers can gradually reduce their dependence and transition to alternative treatments. While this process is challenging, it often initiates a long journey toward regaining control over pain that has significantly impacted their lives, thereby helping them avoid the detrimental consequences of opioid addiction.