GIGO opioid and "low back pain" meta-analysis

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

drusso

Full Member
Moderator Emeritus
Lifetime Donor
Joined
Nov 21, 1998
Messages
12,530
Reaction score
6,917
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis

Christina Abdel Shaheed, PhD1,2; Chris G. Maher, PhD3,4; Kylie A. Williams, PhD5; Richard Day, MD6,7; Andrew J. McLachlan, PhD1,8
[+-] Author Affiliations
1The George Institute for Global Health, Sydney, Australia
2School of Medicine, Western Sydney University, Penrith, Australia
3Musculoskeletal Division, The George Institute for Global Health, Sydney, Australia
4Sydney Medical School, University of Sydney, Sydney, Australia
5Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
6Department of Clinical Pharmacology, St Vincent’s Hospital and St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
7School of Medical Sciences, University of New South Wales, Sydney, Australia
8Centre for Education and Research on Ageing, Sydney, Australia

JAMA Intern Med
. Published online May 23, 2016. doi:10.1001/jamainternmed.2016.1251

Importance Opioid analgesics are commonly used for low back pain, however, to our knowledge there has been no systematic evaluation of the effect of opioid dose and use of enrichment study design on estimates of treatment effect.

Objective To evaluate efficacy and tolerability of opioids in the management of back pain; and investigate the effect of opioid dose and use of an enrichment study design on treatment effect.

Data Sources Medline, EMBASE, CENTRAL, CINAHL, and PsycINFO (inception to September 2015) with citation tracking from eligible randomized clinical trials (RCTs).

Study Selection Placebo-controlled RCTs in any language.

Data Extraction and Synthesis Two authors independently extracted data and assessed risk of bias. Data were pooled using a random effects model with strength of evidence assessed using the grading of recommendations assessment, development, and evaluation (GRADE).

Main Outcomes and Measures The primary outcome measure was pain. Pain and disability outcomes were converted to a common 0 to 100 scale, with effects greater than 20 points considered clinically important.

Results Of 20 included RCTs of opioid analgesics (with a total of 7925 participants), 13 trials (3419 participants) evaluated short-term effects on chronic low back pain, and no placebo-controlled trials enrolled patients with acute low back pain. In half of these 13 trials, at least 50% of participants withdrew owing to adverse events or lack of efficacy. There was moderate-quality evidence that opioid analgesics reduce pain in the short term; mean difference (MD), −10.1 (95% CI, −12.8 to −7.4). Meta-regression revealed a 12.0 point greater pain relief for every 1 log unit increase in morphine equivalent dose (P = .046). Clinically important pain relief was not observed within the dose range evaluated (40.0-240.0-mg morphine equivalents per day). There was no significant effect of enrichment study design.

Conclusions and Relevance For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses. Evidence on long-term efficacy is lacking. The efficacy of opioid analgesics in acute low back pain is unknown.

Members don't see this ad.
 
Why so negative?

This reinforces that there is no reason to use opioids for chronic back pain, and hopefully it helps someone get tenure....


Sent from my iPhone using SDN mobile
 
Top