Opioid therapy for chronic noncancer back pain. A randomized prospective study.
METHODS
A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain.


OBJECTIVE
To examine the long-term safety and efficacy of chronic opioid therapy in a randomized trial of patients with back pain.


METHODS
All participants underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. All patients then were assigned to a titrated dose of opioids for 16 weeks and then gradually tapered off their medication for 12 weeks. Finally, all participants were monitored for a 1-month posttreatment washout period. Each patient was called once a week for a report on pain, activity, mood, medication, hours awake, and adverse effects and was monitored carefully for signs of abuse and noncompliance.


RESULTS
Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. During the titration phase, patients also reported significantly less pain and improved mood. Few differences were found in activity or hours asleep, or between average pretreatment and posttreatment phone-interview and questionnaire variables. No adverse events occurred, and only one participant showed signs of abuse behavior.


CONCLUSIONS
The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.
Jamison
R N
RN
Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Raymond
S A
SA
Slawsby
E A
EA
Nedeljkovic
S S
SS
Katz
N P
NP
D000203:Activities of Daily Living; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009288:Naproxen / Q000009:adverse effects / Q000627:therapeutic use; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D011446:Prospective Studies; D012890:Sleep / Q000187:drug effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009288:Naproxen; D009020:Morphine; D010098:Oxycodone