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Pain relievers of the addictive class of drugs commonly known as “narcotics,” such as OxycontinTM and VicodinTM, provide no advantage over non-narcotics for relieving chronic back pain, and additionally carry a high risk of addiction.

A team of 7 physicians and medical researchers analyzed data from 38 previously published studies that looked at the use of narcotics for back pain. Results were published in the Annals of Internal Medicine.

Narcotics, also known as “opioids,” are commonly prescribed for chronic back pain and may be effective for short-term pain relief, the study suggested. Although opioid prescribing rates for back pain varied widely between studies, ranging from 3 percent up to 66 percent of cases, the data from four studies revealed no significant pain-relieving advantage for opioids over either placebo or non-opioid drugs, and an analysis of five other studies showed no significant drop in pain.

Study author Dr. Bridget A. Martell said she and her colleagues did what is known as a meta-analysis, pooling the results of the 38 previously published studies. “The meta-analysis does not show statistical significance that opioids work any better than placebo,” she said, although, “they possibly work for short-term relief.”

Potential for substance abuse

Chronic back pain is statistically the second most common symptom presented to doctors in the United States. Treatments can include simple exercise therapy or over-the-counter painkillers, but can also include powerful non-steroidal anti-inflammatory drugs (NSAIDs) as well as antidepressants, Acupuncture and electrical stimulation. Many of these approaches to treatment are ineffective. When such treatments fail, doctors often turn to addictive prescription opioid painkillers.

The percentage of subjects with a substance use disorder at some point in their lives ranged from 36 percent to 56 percent. Up to 43 percent of subjects had a current substance use disorder. Between 5 percent and 24 percent of subjects showed “aberrant medication-taking behaviors,” the investigators noted.

Long-term efficacy is unclear, according to the study. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases.

“The findings in this review suggest that clinicians should reconsider treating chronic back pain with opioid medications, and consider other treatments with similar benefits yet fewer long-term adverse effects,” the report states.

SOURCE: Annals of Internal Medicine January 16, 2007