Takaisin Tulosta

Opioids for chronic low back pain

Evidence summaries
Editors
Last reviewed as up-to-date 3.9.2013Completely updated

Level of evidence: B

Opioids appear to reduce pain but seem to have minimal effect on function in patients with chronic low back pain.

A Cochrane review «»1 «Chaparro LE, Furlan AD, Deshpande A et al. Opioids...»1 included 15 studies with a total of 5540 subjects. Tramadol was examined in five trials with 1378 participants, transdermal buprenorphine in two trials with 653 participants and strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol) in six trials with 1887 participants.

Tramadol was found to be better than placebo for pain (SMD -0.55, 95% CI -0.66 to -0.44) and function (SMD -0.18, 95% CI -0.29 to -0.07). Transdermal buprenorphine may make little difference for pain (SMD -2.47, 95%CI -2.69 to -2.25), but no difference compared to placebo for function (SMD -0.14, 95%CI -0.53 to 0.25). Strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol), were better than placebo for pain (SMD -0.43, 95%CI -0.52 to -0.33) and function (SMD -0.26, 95% CI -0.37 to -0.15).

Comment: The level of evidence is downgraded by study quality (inadequate intention-to-treat adherence and study duration) and limited interpretation of functional improvement.

References

  1. Chaparro LE, Furlan AD, Deshpande A et al. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 2013;8():CD004959. «PMID: 23983011»PubMed