Placebo Equals Opioids in Treating Acute Back and Neck Pain

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According to a groundbreaking study by the University of Sydney, opioid-based painkillers are no more helpful than a placebo at treating acute neck and back discomfort and may even be harmful. According to the researchers, this demonstrates why current treatment recommendations should be changed to forbid the consumption of opioids for this reason.  

Daily, lower back and neck pain affects more than 577 million people globally. In Australia, between 40% and 70% of people who complain of neck and back pain are given opioids to treat their pain, despite efforts around the world to minimize the use of these drugs. 

Nearly 350 individuals were enrolled in the OPAL experiment across 157 medical centers and hospital emergency room sites. A six-week regimen of a routinely administered opioid or a placebo was randomly assigned to participants with acute or abrupt and typically transient back or neck pain. Additionally, both groups got conventional treatment, which included recommendations for avoiding bed rest and maintaining an active lifestyle. Participants were monitored for 52 weeks. The Lancet publishes the trial’s outcomes. 

These are the study’s findings:  

Opioids did not alleviate pain significantly more than a placebo at six weeks. At a long-term follow-up, the placebo group had improved quality of life and pain outcomes. 

Patients who received opioids had a slight but appreciably increased chance of abusing the drugs 12 months after finishing their brief course of treatment. According to the research team, opioids can be used as a last resort for back and neck pain if all other pharmacological alternatives have failed. However, this study shows that opioids shouldn’t be advised at all. 

Lead researcher Professor Christine Lin from Sydney Musculoskeletal Health, a project of the University of Sydney, Sydney Local Health District, and Northern Sydney Local Health District, said, “We have demonstrated that there is no benefit to prescribing an opioid for pain management in people with acute back or neck pain, and in fact, it could cause harm in the long-term even with only a short course of treatment.” 

Opioids shouldn’t be suggested for severe neck and back pain, not even when a patient has not responded well to other pharmacological treatments that have been tried. The study adds to earlier research on the use of opioids for chronic (long-term) low back pain, which indicated a modest benefit in treatment but an elevated risk of damage. 

One of the top global health priorities is lowering opioid usage. Opioids should only be used when there is proof that the benefits outweigh the risks, healthcare professionals worldwide have advised due to the severe danger of harm to individuals and society. 

In recent years, according to co-author Professor Chris Maher, attention has shifted from opioids to non-opioid therapies for low back pain, emphasizing psychological therapy and straightforward analgesics such as anti-inflammatory drugs (called NSAIDs). 



According to Professor Maher, also of Sydney Musculoskeletal Health, “this study proves that the first line management of acute low back pain and neck pain should rely on reassurance and advice to stay active, and simple analgesics like non-steroidal anti-inflammatory drugs if necessary.” 

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