title: Long-term opioid analgesic therapy for severe refractory lumbar spine pain.
abstract: OBJECTIVE
  To determine the effect of opioid analgesics on pain and function in patients with severe, refractory low back pain and to see if any benefits were sustained long term.
  
  
  METHODS
  Longitudinal evaluation was conducted in two stages. Stage I was an opioid trial, and stage II was long-term treatment. Treated patients were compared with dropouts and trial failures.
  
  
  METHODS
  Pain was measured by the Numerical Rating Scale (NRS) and function was measured by the Oswestry Low Back Disability Score (OSW). Outcomes were evaluated by patient questionnaire and therefore not subject to investigator bias.
  
  
  METHODS
  Private office practice.
  
  
  METHODS
  Patients were treated for 6-12 weeks with a long-acting or sustained-release opioid. Those who improved significantly were treated long term. The treatment group was compared with dropouts and failures.
  
  
  RESULTS
  Thirty-three patients underwent opioid trial. Treatment was discontinued because of intolerable side effects in 5 patients. In the remaining 28, mean NRS improved from 8.6 to 5.9 (p < 0.001), and mean OSW improved from 64 to 54 (p < 0.001). There were 21 patients treated long term (mean, 32 months). NRS improved from 8.45 to 4.90 (p < 0.001), and OSW improved from 64 to 50 (p < 0.001). Two patients returned to work. The changes in pain and function in the treatment group were significantly better than the comparison group. There was no drug diversion, addictive behavior, or organ toxicity. Doses remained stable.
  
  
  CONCLUSIONS
  Long-term opioid analgesic therapy is reasonable treatment for some well-selected patients with refractory low back pain who have failed all other forms of care.
authors.affiliation: SpineCare Medical Group, San Francisco Spine Institute, Daly City, California 94015, USA.
authors.forename: J
authors.initials: J
authors.lastname: Schofferman
mesh_terms: D006801:Humans; D007278:Injections, Spinal; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology*; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D009294:Narcotics / Q000627:therapeutic use*; D010147:Pain Measurement; D013997:Time Factors
chemical_list: D009294:Narcotics