There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
The prevalence, efficacy, and risk for addiction for persons receiving opioids for
chronic back pain are unclear.
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.
English-language studies from MEDLINE (1966-March 2005), EMBASE (1966-March 2005),
Cochrane Central Register of Controlled Clinical Trials (to 4th quarter 2004), PsychInfo
(1966-March 2005), and retrieved references.
Articles that studied an adult, nonobstetric sample; used oral, topical, or transdermal
opioids; and focused on treatment for chronic back pain.
Two investigators independently extracted data and determined study quality.
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, -0.199 composite standardized mean
difference [95% CI, -0.49 to 0.11]; P = 0.136). Meta-analysis of the 5 studies directly
comparing the efficacy of different opioids demonstrated a nonsignificant reduction
in pain from baseline (g, -0.93 composite standardized mean difference [CI, -1.89
to -0.03]; P = 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%.
Retrieval and publication biases and poor study quality. No trial evaluating the efficacy
of opioids was longer than 16 weeks.
Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term
pain relief. Long-term efficacy (> or =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.
[1
]From Yale University School of Medicine, New Haven, Connecticut; VA Connecticut Health
Care System, West Haven, Connecticut; and University of Pennsylvania School of Medicine,
Philadelphia, Pennsylvania.