Can opioids be a decisive solution for back pain?

Chronic pain has a very detrimental effect on people’s lives, as it interferes directly or indirectly with our ability to carry out the activities of daily, work or family life. Not only for the individual himself, but also for those around him, especially the family. In fact, according to the Spanish Pain Society, 17% of Spaniards (that is, one in six) suffer from chronic pain.

Normally, the most common cause of chronic pain is low back pain. In this type of situation, it is common for the patient to be offered to take morphine or some type of medicine derived from morphine to be able to endure the pain, since its effects are the most powerful in eliminating the pain. In this article, we will explain in detail the risks and benefits we can expect from opioid treatment for chronic low back pain.

What are the positive and negative effects of opioids?

The effect that opioid analgesics have on the central nervous system allows pain to be inhibited. The opioid analgesics most commonly used to treat pain are morphine, fentanyl, oxycodone and tapentadol.

The use of these types of drugs is key for the correct treatment of pain in some pathologies. However, it should be emphasized that indiscriminate use of these substances can lead to health problems not only at the individual level, but also in society.

The benefit of their use in oncology patients is clear and their high effectiveness is not the source of the problem. What may pose a health risk is the considerable increase in recent years of their use in the treatment of chronic non-cancer pain, calling into question the ratio of their benefits versus the safety they offer.

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Opioid overdose: the narcotic death crisis in the U.S.

There is an opioid crisis today. In the U.S., for example, opioid use has spread to a very substantial portion of the population. This has led to skyrocketing cases of addiction and overdose. In the state of Ohio, in 2017 we could find that the sale of fentanyl (an opioid 50 times more potent than heroin) was free.

The rate of opioid deaths in Ohio is 39.2 per 100,000 people, compared to the national average of 14.6, and most of those deaths have been caused by poisonings from excessive fentalin use.

Recently, news broke that a public health emergency had been declared in the U.S. over this growing problem. The uncontrolled use of these substances is causing thousands of deaths and many other negative effects.

Many pharmaceutical companies, such as Johnson & Johnson, have been blamed for the massive distribution of opiates, and have been forced to pay high damages for any harm they may have caused.

What are the side effects of opioid drugs?

There are short-term side effects from the use of opioids such as constipation, dry mouth, sedation or nausea that in many cases prevent patients from taking this type of treatment, however, these side effects are usually temporary and do not usually cause health problems.

Of greatest concern to patients and professionals are the side effects of long-term use. These are mainly dependence (addiction and withdrawal) and tolerance (decreased effectiveness). In small doses and under medical supervision, these side effects are minimal, but should always be kept in mind.

Tolerance and addiction: two possible side effects of morphine to be aware of

Tolerance causes an increasing need in the patient to match the desired effect. Only if doses are low and properly controlled can this problem be minimized.

The possible addiction produced by opioids is a concern and causes many people to refuse to take these drugs out of ignorance or fear. Although the risk of addiction exists, it occurs very infrequently and only in predisposed young people.

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It is necessary to inform the patient that in small doses and under medical supervision, these side effects are minimal, but they should always be taken into account.

Are opioids effective in the treatment of low back pain?

Although opioid analgesics can provide temporary and moderate pain relief for chronic low back pain, they are not a complete solution for those who suffer from it. A team of physicians conducted a study (published in JAMA Internal Medicine) on the use of these drugs in chronic low back pain, and concluded that the use of morphine derivatives has a minimal long-term effect in the treatment of chronic low back pain. Furthermore, practically half of the patients who participated in the research did not tolerate them.

Opioids are not the answer for all types of pain. For the most common pain, somatic pain, opioids manage to relieve this type of pain well. It is a mechanical and localized pain, like the pain we might experience in a fracture or sprained ankle, for example.

But, on the other hand, low back pain can affect the nerve structures for a long time, which in turn produces a type of neuropathic pain with memory (central sensitization). This is important to note, because this type of pain does not respond well to the effects of opioids.

Long-term side effects are also consequences that we must consider very seriously. According to experts, one of the reasons why it is necessary to limit the use of opioids to the minimum necessary is that they can produce a number of long-term side effects, especially in the elderly.

Another issue that should be pointed out is the fact that patients suffering from low back pain should keep active and avoid prolonged rest in order to improve pain, prevent sedentary lifestyles and have a healthy lifestyle.

The uncontrolled use of opioids in young people carries with it a significant risk to their health, and if they are necessary, they should only be used in justified circumstances, and as briefly as possible.

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Opioid-derived drugs cannot be a valid long-term solution to relieve chronic low back pain in most cases, and it is always advisable to opt for percutaneous interventional measures before starting opioid treatment.

That said, opioids can be used in low doses in certain cases, such as chronic vertebral fractures, and can even be useful if used in conjunction with other chronic low back pain medications.

Key points in the use of opioids for the treatment of low back pain

The growing opioid crisis in the U.S. has put the country’s healthcare system in turmoil. These drugs put the patient’s life at risk when used indiscriminately and, above all, without qualified medical supervision.

In Spain we are far from experiencing a similar situation, thanks to the fact that the prescription of opioids at high doses is supervised by the Pain Units in most cases. It is a high priority that the specialists who prescribe this type of medication have adequate knowledge and experience about its use, in order to be able to guide the patient on the limitations and guidelines to be followed for its correct and moderate use.

The opioid usually has a short-term positive effect, partially relieving pain temporarily, but we must bear in mind that the effect is less and less in the long term, becoming minimal according to studies and expert opinions.

Thanks to anesthetic techniques we can relieve pain in many cases without the need to prescribe this type of drugs. Opioid treatments should be for very specific cases, when other interventional measures fail, and always taking into account their effects and, of course, that we should not abuse their prescription.