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 (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.
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, −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%.
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 (≥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.
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Author, Article, and Disclosure Information
Affiliations:
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.
Grant Support: Dr. Martell was supported by a Veterans Administration Career Development Award during the conduct of this study.
Disclosures: None disclosed.
Corresponding Author: David A. Fiellin, MD, Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025; e-mail, david.
Current Author Addresses: Dr. Martell: Pfizer, New Haven Clinical Research Unit, 50 Pequot Avenue, Mailstop 3000, New London, CT 06330.
Drs. Kerns and Kosten: VA Connecticut Health Care System, Psychology Service, 116B, 950 Campbell Avenue, West Haven, CT 06516.
Dr. Morales: Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 626 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.
Drs. Fiellin, O'Connor, and Becker: Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025.
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