It’s time to really talk about opioid use. Chronic pain is no laughing matter, and it’s nothing to be flippant about. We see thousands of patients a year who suffer terribly from lower back pain and other conditions. The struggles that they face in their daily lives, and the challenges that their chronic pain presents to their friends and family, are very real. We take them very seriously. We live our mission of helping patients get their lives back every day, and we want them to know that we consider them like our own family. And as with our own family, it’s time for some tough talk: opioids are probably not helping your lower back pain. In fact, opioids may be making your lower back pain worse.
Research on opioids for lower back pain comes up short
For years now researchers have been looking deeply into opioids for chronic pain of all types. They have amassed hundreds of studies over decades looking at opioids for both short- and long-term use.
Again and again, the evidence shows that opioids have limited effectiveness in treating lower back pain. The most recent findings come just weeks before this post. In a meta-analysis of 20 trials looking at the safety and side effects of opioids for lower back pain with no clear identifiable cause, researchers found that opioids had about half the effectiveness for pain relief as that of an inactive placebo. In addition, many of the study participants were unable to handle the side effects of opioids, with over 50% experiencing side effects so severe that they withdrew from the studies.
So why are doctors and patients alike still working under the assumption that opioids are effective?
A brief history of opioids and lower back pain
Opioids have been around in some form since 3400 BCE (in the form of poppies). Fast forward thousands of years to the 1990s when undertreatment of pain became a rallying cry for more aggressive interventions and pain management.
One of these interventions was the development of extended release opioids, including morphine, oxycodone, and fentanyl. Pain lobbyists pushed for wide release and prescription of opioids for all types of pain beyond non-cancer pain, which has generally always been the standard of care.
These slow-release medications produced in pain patients an overwhelming feeling of euphoria and a perception of pain relief. It stands to reason that a person suffering for years from chronic pain would embrace this feeling, but there was one huge caveat: the body’s adaptability to this type of medication.
Doctors began prescribing these miracle drugs to excess, with patients understandably clamoring for relief.
We want to note again that we truly understand why patients and their doctors adopted opioid prescription practices so readily. To see patients who had been suffering for decades report pain-free days and a restored hope for the future is what every doctor hopes for.
But in the ten-year period from 1998 to 2008, opioid prescriptions doubled. Along with that prescription doubling came over 730,000 visits to the emergency room due to misuse or abuse of prescription opioids, doubling in just five years. In 2002, over six million people in the U.S. were abusing prescription drugs.
The changing face of addiction
The vast majority of those with opioid dependence are not who you might think they are. Many people who begin taking opioids for acute pain find themselves physically dependent on them in a short time. In fact, many patients leave the hospital physically dependent on opioids after an operation, suffering minor withdrawal symptoms that they may believe is a cold or a virus contracted at the hospital.
It should be noted that physical dependence is not the same as addiction. Physical dependence on opioids is the same as physical dependence on insulin for Type 1 diabetics. The body becomes used to functioning in a certain way with their medications and struggles to acclimate after those medications are withdrawn. Addiction is characterized as a behavioral component that usually accompanies a physical dependence.
That being said, it is remarkably easy to become dependent on opioids, and the longer you take them, the more likely you are to develop both physical dependence and an increased tolerance to their effects. Patients may find that previous prescriptions may no longer help with their pain, and they may begin to suffer withdrawal symptoms such as nausea, fatigue, muscle pain and weakness, and irritability or anger.
The person who finds themselves “addicted” to opioids may still be able to function in daily life, but the longer they take opioids, the more dangerous they become. Long-term use is associated with disruption to the menstrual cycle, a weakened immune system, and affected sex hormones. Additionally, side effects may include nausea, constipation, and difficulty concentrating, problems which worsen as time goes on.
Roger Chou, M.D., associate professor of medicine at Oregon Health and Science University in Portland points out that new research has utterly debunked opioids’ effectiveness against lower back pain, noting:
“The old perception about opioids is that they are reasonably effective and safe for chronic pain, but what we’ve come to realize is for many types of pain they don’t work all that well and are actually associated with significant harm.”
Gary Franklin, M.D., research professor of environmental and occupational health sciences at University of Washington in Seattle believes that the evidence has become overwhelming against prescribing opioids for chronic pain:
“What concerns me is that there is no clear evidence that people who take opioids over the long term can do more or get around more easily. But we do know that the higher the dose of the drug and the longer you take it, the greater your risk.”
Opioids – what are they good for?
In specific, controlled instances, opioids work well for pain management. End-stage cancer pain and pain as a result of surgery or in the acute, short-term stage of an injury are two times when opioids are recommended and are the standard of care.
But for chronic lower back pain? There is no evidence that the benefits from opioids outweigh the risks. Indeed, it does not seem that opioids have any more affect on chronic lower back pain than a placebo.
Opioids and chronic lower back pain – the bottom line
The bottom line for opioids and chronic lower back pain is this: there is no evidence that opioids are effective in treating chronic lower back pain, and the risk of side effects, dependence, and death increase the longer a patient takes them.
If you are currently taking opioids for chronic lower back pain, it’s time to talk to your doctor about other options. It is never too late to make changes in your health, and a conversation with your pain management specialist is a great place to start.
If you feel you might have become dependent on your prescription pain medications, reach out for help today. You and your family deserve better.