Opioids Not a Good Idea for Lower Back Pain

Adding opioids or skeletal muscle relaxants to traditional nonsteroidal anti-inflammatory drug (NSAID) treatment for acute lower back pain (LBP) provides little improvement in pain management, Bronx researcher have found.

In a study published in the October 20 volume of The Journal of the American Medical Association, Benjamin W. Friedman, MD, MS, of Montefiore Medical Center and Albert Einstein College, Bronx, New York, tracked pain levels of 323 participants for three months following their ED visit. Screening excluded patients with a history of chronic LBP, regular analgesic use or radicular symptoms.

Researchers established three groups for the double-blind study. One received naproxen, 500mg, with a placebo. One received naproxen, 500mg, with cyclobenzaprine, 5mg. The last received naproxen, 500mg, with oxycodone, 5mg/acetaminophen, 325mg.

Using the Roland-Morris Disability Questionnaire (RMDQ), doctors then assessed acute pain levels at one week, one month and three months. Researchers found a mean RMDQ improvement of 9.8 in the placebo group, 10.1 in the cyclobenzaprine group and 11.1 in the oxycodone/acetaminophen group at one week.

The mean RMDQ improvement between groups ranged from 0.3 to 1.3, with the greatest differences occurring between the oxycodone/acetaminophen and placebo groups.

In an interview published online on October 19, Friedman noted, “Despite optimal therapy, approximately 50% of patients are still suffering from their acute lower back pain one week after the ED visit. Nearly 25% are still suffering 3 months later."

He said clinical research is needed to define the optimal combination of medication and complementary therapy to improve the outcomes of these patients. “These findings do not support use of these additional medications in this setting,” he said.