Opioid therapy can provide significant pain relief for patients with chronic back pain due to non-cancerous disorders of the spine and is unlikely to lead to the development of tolerance or addiction, according to Minnesota-based investigators.

Concerns regarding efficacy and side effects - as well as the potential for dependence and abuse - have limited the use of opioids for patients with chronic spine-related pain, Dr. Maren L. Mahowald and colleagues from the Minneapolis VA Medical Center point out in the medical journal Arthritis and Rheumatism.

However, narcotic agents do have a role in treatment of pain associated with conditions such as damaged discs, narrowing of the spinal canal, persistent back pain after surgery.

To investigate the safety of opioid treatment for severe back pain, the researches analyzed use of the drugs over three years by 230 spine clinic patients. A total of 152 patients were prescribed opioids - most commonly codeine, oxycodone, propoxyphene and tramadol. Ninety-four patients took them for less than 3 months.

Interviews conducted with a cross-section of the opioid users showed that these agents significantly reduced the severity of back pain, from 8.3 to 4.5 on a 10-point scale. The patients did not find that the drugs became less effective over time, and there was no significant increase in the average daily dose of opioid over the study period.

The authors conclude that, “doubts or concerns about opioid efficacy, toxicity, tolerance, and abuse or addiction should not be used to justify the withholding of opioids from patients who have pain related to defined spinal diseases.”

This study, they add, “provides clinical evidence to support and protect physicians treating patients with chronic musculoskeletal diseases, who may be reluctant to prescribe opioids because of possible sanctions from regulatory agencies.”

SOURCE: Arthritis and Rheumatism, January 2005.