Opioids No More Effective Than Placebo for Acute Back and Neck Pain

Opioid pain-relieving medicines are not more effective than a placebo in relieving acute back and neck pain and may even cause harm, according to a world-first trial led by the University of Sydney.

The researchers say this is proof that treatment guidelines should be updated to advise against the use of opioids for this purpose.

Over 577 million people worldwide experience low back and neck pain at any one time.

Despite a global push to reduce the use of opioids, in Australia approximately 40 to 70 percent of those who present with neck and back complaints are prescribed opioids for their pain.

The OPAL trial recruited close to 350 participants from 157 primary care and emergency department sites. Participants with acute-meaning sudden and generally short-term-back or neck pain were randomly allocated to a six-week course of a commonly prescribed opioid or a placebo.

Both groups also received standard care including advice to avoid bed rest and stay active. Participants were followed for 52 weeks.

The results of the trial are published in The Lancet today.

At six weeks, those who received opioids did not have better pain relief than those given the placebo.

Quality of life and pain outcomes at long-term follow-up were better in the placebo group.

Patients who received opioids were at a small but significantly higher risk of opioid misuse 12-months after their short course of medication.

The study complements previous research into opioid use for chronic (long-term) low back pain which found a small treatment benefit, but increased risk of harm.

Reducing the overuse of opioids is a global health priority. Medical authorities around the world have cautioned that due to the significant risk of harm to individuals and society, opioids should only be used where there is evidence that the benefits outweigh the harms.

Co-author Professor Chris Maher said in recent years there has been a shift in focus from opioid to non-opioid treatments for low back pain, with a focus on physical and psychological therapies and simple analgesics such as anti-inflammatory medicines (called NSAIDs).

Professor Andrew McLachlan, Dean of Sydney Pharmacy School and co-investigator, said the Lancet study is important and should influence prescribing and dispensing of these medicines as Australia faces rising rates of opioid use. According to Australia’s Therapeutic Goods Administration, every day in Australia nearly 150 hospitalisations and 14 emergency department admissions involve issues relating to opioid use, and three people die from the harm that results from prescription opioid use.


Caitlin M P Jones, Richard O Day, Bart W Koes, Jane Latimer, Chris G Maher, Andrew J McLachlan, Laurent Billot, Sana Shan, Chung-Wei Christine Lin, Hanan McLachlan, Melissa Webb, Melanie Hamilton, Harbeer Ahedi, Angie Barber, Wendy Mak, Stephanie Mathieson, Veronika Petrova, Severine Bompoint, Sana Shan, Bridin Murnion, Nicholas Buckley, Apo Demirkol, Paul Wrigley, Christopher Needs, Louise Brooks, Samuel Cantori, Paul Preisz, James Aitken, Sujata Allan, Michael Burke, Greg Cameron, Francisco Javier Valencia Cepeda, Christopher Davis, Jayasree Dullur, Joseph Emmanuel, Catherine Errey, Sabine Fieuw-Makaroff, Adam Gaudry, L Genua, Ian Longhurst, Kenneth McCroary, Diana Merhi, Tanya Nguyen, Zahra Rassoly Obayd, Michelle Penm, Sharan Pobbathi, William S Poh, Paul Schnitzler, Sabiha Shahnaz, Ven Tan, Danny Tang, Brian Tan, Win Kyaw Thu, Thrasivolous Triantopolous, Ramana Venkatesan, Wicky Chun Fai Wong, Shu Ching Yang. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. The Lancet, 2023; DOI: 10.1016/S0140-6736(23)00404-X

University of Sydney. (2023, June 28). Opioids no more effective than placebo for acute back and neck pain: Evidence calls for change to treatment guidelines. ScienceDaily. Retrieved July 3, 2023 from www.sciencedaily.com/releases/2023/06/230628194941.htm

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