Opioids for chronic low-back pain

Deshpande, Amol; Furlan, Andrea D.; Mailis, Angela; Atlas, Steven J.; Turk, D.

doi:10.1002/14651858.cd004959.pub3

Cited by 125 publications

(56 citation statements)

References 44 publications

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“…Women become amenorrheic or develop anovulatory menstrual cycles and reported reduced libido soon after initiating treatment with sustained-action opioid analgesics [103]. Hormone supplementation with testosterone in males and estrogen and progestin in females improves libido [47,98,105]. Infertility is a major negative health consequence of low levels of GnRH, FSH and LH in women.…”

Section: Opioid Endocrinopathy -Effects Of Suppression Of Hypothalamomentioning

confidence: 99%

“…Some of the reviews reanalyzed pooled data from multiple RCTs and showed opioids have limited efficacy in reducing pain (TABLE 3). Two Cochrane reviews found non-significant pain reduction with opioids in chronic low back pain (LBP) patients [32,47]. Opioids decreased pain in osteoarthritis (OA) of hip or knee joint, but the overall benefit was small, corresponding to a difference in pain scores of 0.9 cm on a 10 cm visual analog scale (VAS) or 15% pain reduction [48].…”

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confidence: 99%

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Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Sehgal¹,

Colson²,

Smith³

2013

Expert Review of Neurotherapeutics

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Chronic non-cancer pain (CNCP) is a disabling chronic condition with a high prevalence rate around the world. Opioids are routinely prescribed for treatment of chronic pain (CP). In the past two decades there has been a massive increase in the number of opioid prescriptions, prescribed daily opioid doses and overall opioid availability. Many more patients with CNCP receive high doses of long-acting opioids on a long-term basis. Yet CP and related disability rates remain high, and majority of the patients with CNCP are dissatisfied with their treatments. Intersecting with the upward trajectory in opioid use are the increasing trends in opioid related adverse effects, especially prescription drug abuse, addiction and overdose deaths. This complex situation raises questions on the relevance of opioid therapy in the treatment of CNCP. This article reviews current evidence on opioid effectiveness, the benefits and harms of long-term therapy in CNCP.

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Section: Opioid Endocrinopathy -Effects Of Suppression Of Hypothalamomentioning

confidence: 99%

mentioning

confidence: 99%

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Sehgal¹,

Colson²,

Smith³

2013

Expert Review of Neurotherapeutics

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“…14 In addition to NSAIDs and opioids, other therapies used for the treatment of CLBP include antidepressants, paracetamol (acetaminophen), muscle relaxants and steroids. 15 Although NSAIDs and opioids are the most widely used of these treatments, there is still a lack of sufficient evidence regarding their effectiveness in managing CLBP 3,14,16,17 or in improving daily functioning, 3,14,16 -21 whilst concerns regarding their long-term safety and tolerability still exist. 17,19,22,23 The aim of the two randomized, parallelgroup studies reported here was to compare the analgesic efficacy, tolerability and safety of celecoxib, a cyclo-oxygenase-2 (COX-2) selective NSAID, and tramadol hydrochloride (HCl), a 'weak' opioid with relatively low addiction potential, in patients with CLBP.…”

Section: Celecoxib Versus Tramadol In Clbp Patientsmentioning

confidence: 99%

“…The analgesic efficacy of celecoxib has been shown to be similar to that of non-selective NSAIDs, 41 -44 while recent systematic reviews have concluded that opioids may be effective in reducing pain and improving functionality in subjects with chronic pain. 17,19,21 As previously discussed, safety is also a key consideration when assessing analgesic therapies; the welldocumented GI and CV risks associated with both non-selective and COX-2 selective NSAIDs 29 and the abuse potential of stronger opioids, such as oxycodone and morphine 45 should be considered before deciding on the most appropriate treatment.…”

Section: Celecoxib Versus Tramadol In Clbp Patientsmentioning

confidence: 99%

The Effectiveness of a Weak Opioid Medication versus a Cyclo-Oxygenase-2 (COX-2) Selective Non-Steroidal Anti-Inflammatory Drug in Treating Flare-Up of Chronic Low-Back Pain: Results from Two Randomized, Double-Blind, 6-Week Studies

O’Donnell

Ekman²,

Spalding

et al. 2009

J Int Med Res

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Two 6-week studies compared the analgesic efficacy, tolerability and safety of a non-steroidal anti-inflammatory drug (celecoxib 200 mg twice a day [bid]) and an opioid (tramadol HCl 50 mg four times a day [qid]) in subjects with chronic low-back pain (CLBP). Successful responders (primary endpoint) were defined as subjects completing 6 weeks of treatment and having ≥ 30% improvement on the Numerical Rating Scale for pain. A total of 796 and 802 subjects were randomized to treatment in study 1 and study 2, respectively. A significantly greater percentage of celecoxib-treated subjects were successful responders compared with tramadol HCl-treated subjects (study 1: 63.2% versus 49.9%, respectively; study 2: 64.1% versus 55.1%, respectively). Fewer adverse events (AEs) and serious AEs were reported in the celecoxib-treated group. Overall, celecoxib 200 mg bid was more effective than tramadol HCl 50 mg qid in the treatment of CLBP, with fewer AEs reported.

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“…These treatments range from educational programs [8] to behavioural cognitive therapy [9], medication [10], electrophysical agents [11], manual therapy [12-14] (e.g. joint mobilisation/manipulation, myofascial release), general exercises [15] and specific spinal stabilisation exercises [16], among others [7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of adding the kinesio taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: a randomised controlled trial

Added

Costa

Fukuda

et al. 2013

BMC Musculoskelet Disord

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BackgroundChronic nonspecific low back pain is a significant health condition with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physiotherapy, that have already been recommended by the current clinical practice guidelines in robust and high-quality randomised controlled trials. We aim to determine the effectiveness of the addition of the use of Kinesio Taping in patients with chronic nonspecific low back pain who receive guideline-endorsed conventional physiotherapy.Methods/designOne hundred and forty-eight patients will be randomly allocated to receive either conventional physiotherapy, which consists of a combination of manual therapy techniques, general exercises, and specific stabilisation exercises (Guideline-Endorsed Conventional Physiotherapy Group) or to receive conventional physiotherapy with the addition of Kinesio Taping to the lumbar spine (Conventional Physiotherapy plus Kinesio Taping Group) over a period of 5 weeks (10 sessions of treatment). Clinical outcomes (pain intensity, disability and global perceived effect) will be collected at baseline and at 5 weeks, 3 months, and 6 months after randomisation. We will also collect satisfaction with care and adverse effects after treatment. Data will be collected by a blinded assessor. All statistical analysis will be conducted following the principles of intention to treat, and the effects of treatment will be calculated using Linear Mixed Models.DiscussionThe results of this study will provide new information about the usefulness of Kinesio Taping as an additional component of a guideline-endorsed physiotherapy program in patients with chronic nonspecific low back pain.

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Opioids for chronic low-back pain

Cited by 125 publications

References 44 publications

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy

The Effectiveness of a Weak Opioid Medication versus a Cyclo-Oxygenase-2 (COX-2) Selective Non-Steroidal Anti-Inflammatory Drug in Treating Flare-Up of Chronic Low-Back Pain: Results from Two Randomized, Double-Blind, 6-Week Studies

Efficacy of adding the kinesio taping method to guideline-endorsed conventional physiotherapy in patients with chronic nonspecific low back pain: a randomised controlled trial

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