Last week, an expert Food and Drug Administration advisory panel recommended that the agency approve another new narcotic painkiller—Arymo ER, a long-acting form of the opioid morphine. But that thumbs up comes on the heels of yet another analysis—this one looking specifically at low back pain—suggesting that opioids such as OxyContin, Percocet, and Vicodin don’t provide much relief for many people with long-term pain and cause significant harm.

Austin Kessler, 63, says he used various strategies to manage his pain over the six months or so it took to recover from a back injury in the summer of 2014. He described how, when landscaping at his home in Austin, Texas, the strain of lifting a large rock caused him to suffer a “slipped” (or herniated) disc, a condition where the material cushioning the bones of the spine bulges and presses on nerves. “At first, the pain was so excruciating I could barely move,” says Kessler. “My 85-year-old father was pushing me around in a wheelchair.”

His doctor prescribed acetaminophen combined with the opioid hydrocodone (Vicodin and generic), but Kessler only took the drug off and on for a couple of weeks. “After a while, the medication didn’t seem to be helping very much,” he says. “I never considered getting a refill.”

recent review of 20 clinical trials involving a total of nearly 7,300 patients suggests that many people suffering low back pain have a similar experience. Results from the study, published in JAMA Internal Medicine, showed that, overall, opioids helped only a little with pain lasting 3 months or longer, but did not provide what doctors consider “clinically meaningful” relief—which is an improvement of 20 points or more on a 100-point pain scale. Further, half of the participants taking opioids dropped out of their studies early, most often because the drug didn’t work or caused side effects.

“It’s surprising given their reputation as powerful painkillers, that opioids didn’t provide significant relief for people with longer-term low back pain—even at very high doses,” says Andrew McLachlan, Ph.D., a professor of pharmacy at the University of Sydney in Australia and a co-author of the study. In fact, he notes research shows that nonsteroidal anti-inflammatory (NSAID) pain relievers such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve and generic) can work just as well as opioids against chronic pain and are safer for most people.

The Downside of Taking Opioids Longer Term

Opioids can work very well to alleviate pain after surgery or in the first few days after a serious injury. But that pain relief tends to diminish over time as most people quickly develop a tolerance to the drugs. That’s likely one of the main reasons that opioids don’t provide big improvements for people with lingering pain, says McLachlan.

Another issue is the side effects. Opioids commonly cause constipation, nausea, vomiting, headaches, dizziness, sleepiness, and a fuzzy-headed feeling. “Our review demonstrates that many people just don’t tolerate opioids well,” says McLachlan.

Opioids also carry serious risks of addiction, overdose, and even death—especially when taken at high doses or used longer term.

According to McLachlan, this new study adds to a growing body of evidence that the “balance of benefits and risks for the use of opioids for chronic low back pain has changed.” For most patients with long-term pain, he says, “we are discovering that the modest benefits are far outweighed by possible harms.”

Safer Ways to Relieve Low Back Pain

After Kessler was injured, he says he consulted with an orthopedic doctor who recommended surgery, but after getting a second opinion, he opted to try other approaches first. What eventually worked for him was physical therapy that involved a combination of treatments, including massage, stretching, and structured exercise. Evidence supports the effectiveness of exercise and hands-on therapies, according to our report on treating low back pain.

Kessler also had the right idea when it comes to optimizing pain relief from opioid pain drugs. The medications work best and are safer when used for a short time to treat severe pain according to the Centers for Disease Control and Prevention. If you do wind up needing opioids for longer than a couple of weeks, recent guidelines from the agency advise taking the lowest possible dose, for the shortest time necessary to treat your pain.

McLachlan says that the findings of his study also reinforce CDC recommendations that healthcare providers carefully monitor patients taking opioids to make sure that the drugs are actually helping and not causing harmful effects.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).