- Opioid painkillers – which include tramadol, oxycodone and morphine – provide ‘minimal benefit’ for low back pain, review of research has found
- These drugs prescribed for roughly 40 per cent of back pain patients
- But half of patients stop taking them due to side effects or lack of impact
Powerful painkillers doled out in their millions are ineffective against back pain, experts have warned.
A major review of clinical evidence suggests that opioid painkillers – which include tramadol, oxycodone and morphine – provide ‘minimal benefit’ for low back pain.
Yet the drugs are highly addictive, and can be dangerous if taken long term.
Back pain is one of the most common medical complaints seen by GPs, with most people suffering with the problem at some point in their life.
And researchers estimate that opioid painkillers are prescribed in roughly 40 per cent of cases.
But the new research, which combines data from 7,300 patients around the world, suggests that the pills do little good – and may be causing long-term harm.
The study, led by the George Institute for Global Health in Sydney, found that half of patients either suffered side effects or stopped taking the drugs because they did not work.
The team found that even at high doses – above recommended levels – the drugs still provided little clinical benefit.
Study leader Professor Chris Maher said: ‘Taking an opioid analgesic such as oxycodone will reduce pain, but the effect is likely to be small.
‘People have the mistaken belief that opioids are strong pain killers.
‘When you look closely at the evidence from the low back pain trials, a completely different picture emerges.’
His team did not include codeine, which is the mildest opioid painkiller, in the review because no trial data exists.
But Professor Maher said his conclusions extended to codeine as well as the more powerful forms.
The study, published in the journal JAMA Internal Medicine, examined 20 clinical trials involving 7,295 patients.
The authors found that the drugs reduced pain slightly – but to nowhere near the levels considered enough to be clinically effective.
And they warned that if taken long-term they could have severe side effects.
These include addiction, dizziness and falls – as well as deaths from overdose.
One of the problems is that if the drugs are not effective, patients might take higher doses to try and reduce their pain.
Some 50 percent of US patients taking opioid painkillers for three months are still on the same drugs five years later.
And the problem is thought to be at dangerous levels on this side of the Atlantic as well.
Prescriptions of opioids as painkillers in England have more than doubled in the last decade, from 10.7million in 2005 to 23.3million in 2015.
But a major review of clinical evidence has found these painkillers – which include tramadol, oxycodone and morphine – provide ‘minimal benefit’ for low back pain (file image)
Charities estimate there are 32,000 painkiller addicts in Britain, mainly people who have become addicted to the drugs having initially taken them to ease a minor ailment.
In the US one of every 550 patients prescribed opioid painkillers died of an overdose within three years.
Professor Maher said: ‘We know of no other medication routinely used for a non-fatal condition that kills patients so frequently.’
Opioids such as codeine and morphine are strictly controlled in the UK.
All but the weakest doses are available only with a prescription, with just 8mg of codeine – a tiny amount – allowed in over-the-counter forms such as co-codamol.
But British doctors are concerned about the increasing numbers of stronger codeine pills and other opioids given out on prescription by GPs.
Dr Martin Johnson, a chronic pain expert at the Royal College of GPs, said that opioid painkillers are fine for short-term relief, but in the longer term exercises and stretching will be far more effective.
‘You are much better stretching your muscles out and using a hot water bottle,’ he said.
‘Painkillers are appropriate for short-term, intermittent use. They are good tool for you to reduce your pain enough to exercise – that is the best way to use them.’
Richard Francis of Arthritis Research UK, said: ‘Pain is experienced in many different ways, so it’s important for people to speak to their GP about putting together the most up-to-date pain plan for their individual needs.
‘Arthritis, joint and back pain are debilitating, painful conditions that need much better pain treatments.
‘Whilst opioids may be a suitable option for some people to relieve chronic pain when used in the right doses, there are a number of things people can do to help manage lower back pain in addition to pain medication, including physiotherapy and exercise.’