Daily Dose: Opioid Use for Low Back Pain and Neck Pain

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on a study published in The Lancet that examined the safety and efficacy of a judicious short course of an opioid analgesic for acute low back pain (LBP) and neck pain in adults aged ≥18 years.

The study

Between February 2016 and March 2022, investigators recruited 347 individuals who presented at one of 157 primary care or emergency department sites in Australia with ≤12 weeks of LBP or neck pain (or both) of at least moderate intensity. Participants were randomly assigned to receive guideline-recommended care plus either an opioid (n=174) or placebo (n=173) for up to 6 weeks. Participants in the opioid group received up to 20 mg of modified-release oxycodone-naloxone per day orally.

The findings

Results showed no significant difference in pain scores at 6 weeks between the 2 cohorts, with a score of 2.78 in the opioid group and 2.25 in the placebo group.

Pain severity was not significantly different between groups at week 12, however, the between-group difference increased over time and by week 52 there was a small difference favoring placebo, according to researchers.

In addition, 35% of participants in the opioid group and 30% of those in the placebo group reported non-serious adverse events. The most common adverse events reported across both groups were nausea and vomiting, constipation, headache, dizziness, and somnolence.

A note from authors

"Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions."

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