An article in the Journal of the American Board of Family Medicine suggested that long term opioid therapy does not significantly improve outcomes for patients with chronic low back pain. Chronic back pain is back pain lasting longer than 12-weeks. ~ Dr. Broussard
Effectiveness of Long-Term Opioid Therapy for Chronic Low Back Pain
April 02, 2024
Journal of the American Board of Family Medicine: JABFM
TAKE-HOME MESSAGE
- This propensity score–matched retrospective cohort study evaluated the effectiveness of long-term opioid therapy (LTOT) for up to 12 months in treating individuals with chronic low back pain. No difference was observed between the LTOT and control groups with regard to mean pain intensity, back-related disability, or pain impact.
- This study suggests that LTOT for up to 12 months does not significantly improve outcomes for patients with chronic low back pain.
Long-term opioid therapy for chronic low back pain
Study key points
In a 12-month trial involving 402 matched participants with low back pain (LBP), participants who took opioids continuously did not fare better than those who did not with regard to pain intensity, disability, pain impact, or the likelihood of minimally important changes in any outcome.
Relevance
Long-term opioid therapy (LTOT) continues to be a common scenario in the management of chronic LBP in spite of current guidelines. Previous trials we have covered have demonstrated a lack of benefit of opioid vs non-opioid therapy1 as well as association with potential harm. Unfortunately, these trials were for a shorter term or data were not collected from a generalized population. This study attempted to evaluate this question with a longer (12-month) evaluation period, using data from a national registry.
Details
Trial design: Retrospective cohort study
Setting: Participants selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION)
Participants: 402 adults (73.9% female; 55.4 years [SD, 11.9 years]) with chronic LBP identified through a national registry from April 2016 through August 2022. Participants reporting LTOT (>90 days) were matched to opioid nonusers with propensity scores. The mean daily morphine milligram equivalent dosage at baseline was 36.7 (95% CI, 32.8–40.7).
Outcomes
Primary outcomes:
Secondary outcomes involved minimally important changes in primary outcomes.
Findings
There were no differences between LTOT and control groups in:
Author’s conclusions
Using LTOT for up to 12 months is no more effective in improving chronic LBP outcomes than treatment without opioids. Clinicians should consider tapering opioid dosage among LTOT users in accordance with clinical practice guidelines.
Clinical bottom line
These findings reiterate, with longer-term data, what previous studies and clinical guidelines have emphasized. The use of LTOT does not provide advantages over non-opioid treatment in the setting of chronic LBP. In addition, realizing the potential harms of initiation or ongoing therapy in this setting, the authors have recommended appropriate discussion and potential tapering based on current standards.
Reference
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