Background: The prevalence, efficacy, and risk for addiction for persons receiving opioids for chronic back pain are unclear.
Purpose: To determine the prevalence of opioid treatment, whether opioid medications are effective, and the prevalence of substance use disorders among patients receiving opioid medications for chronic back pain.
Data Sources: English-language studies from MEDLINE (1966â€“March 2005), EMBASE (1966â€“March 2005), Cochrane Central Register of Controlled Clinical Trials (to 4th quarter 2004), PsychInfo (1966â€“March 2005), and retrieved references.
Study Selection: Articles that studied an adult, nonobstetric sample; used oral, topical, or transdermal opioids; and focused on treatment for chronic back pain.
Data Extraction: Two investigators independently extracted data and determined study quality.
Data Synthesis: Opioid prescribing varied by treatment setting (range, 3% to 66%). Meta-analysis of the 4 studies assessing the efficacy of opioids compared with placebo or a nonopioid control did not show reduced pain with opioids (g, âˆ’0.199 composite standardized mean difference [95% CI, âˆ’0.49 to 0.11]; PÂ = 0.136). Meta-analysis of the 5 studies directly comparing the efficacy of different opioids demonstrated a nonsignificant reduction in pain from baseline (g, âˆ’0.93 composite standardized mean difference [CI, âˆ’1.89 toÂ âˆ’0.03]; PÂ = 0.055). The prevalence of lifetime substance use disorders ranged from 36% to 56%, and the estimates of the prevalence of current substance use disorders were as high as 43%. Aberrant medication-taking behaviors ranged from 5% to 24%.
Limitations: Retrieval and publication biases and poor study quality. No trial evaluating the efficacy of opioids was longer than 16 weeks.
Conclusions: Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term pain relief. Long-term efficacy (â‰¥16 weeks) is unclear. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases.