Be wary of narcotics to treat back pain

Last updated: May 2009

One too many sets of tennis caused lower-back pain for one of our survey respondents, Janie King, 63, of Kula, Hawaii, and prompted her to see her primary-care doctor. He prescribed the opioid (narcotic) pain reliever Vicodin (acetaminophen and hydrocodone). The drug did little to relieve King's pain and caused severe nausea and vomiting.

Prescriptions have doubled

Our low-back-pain survey found that more than 50 percent of those given a prescription drug received an opioid pain reliever, despite the fact that there is very little research to support the use of opioids for acute low-back pain. Opiods may reduce chronic low-back pain when compared to placebo. But clinical trials have shown that about half of the people who take them suffer adverse effects such as drowsiness, respiratory depression, and gastrointestinal symptoms such as constipation, reflux, heartburn, cramping, nausea, and vomiting.

Moreover, other adverse effects of opioids include a paradoxical increase in pain sensitivity, reduced testosterone levels, and erectile dysfunction. Substance-use disorders, such as overuse, getting drugs from more than one doctor, or giving or selling pills to friends, are also reported to affect about 25 percent of people taking opioids for back pain.

Although the side effects often outweigh the benefits, prescriptions of opioids among patients with spinal disorders more than doubled from 1997 to 2004, at least in part because of pharmaceutical-industry marketing and promotion of the drugs. Emergency-department reports of opioid overdose have risen with the numbers of prescriptions.

In my practice, I find that there are almost always better solutions than opioids for low-back-pain patients. As our survey shows, hands-on therapies (available to subscribers) are very successful, and I almost always prescribe them. Exercise can be beneficial. For most people, the best first-line medicines are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Depending on the circumstances, second-line medications, including muscle relaxants, tricyclic antidepressants, and antiseizure drugs, can help. King reports that she improved after six weeks and has been playing tennis since. Although she's had periodic recurrences of pain, she says she has been sure to avoid opioids.

Orly Avitzur, M.D.

Medical Adviser

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