Risks Associated with Short-Term Opioids for Recent-Onset Low Back and Neck Pain Might Exceed Benefits

Clinical guidelines recommend opioid analgesics for recent-onset low back or neck pain only when other pharmacologic treatments are contraindicated or have not provided relief (NEJM JW Gen Med Apr 15 2017 and Ann Intern Med 2017; 166:514). However, opioids' effectiveness for relieving pain for these conditions is unsupported by robust evidence.

Australian researchers recruited 347 adults with moderate-to-severe recent-onset low back or neck pain (≤12 weeks' duration, preceded by ≥1 month without pain) from primary care practices; patients were randomized to oral oxycodone (as much as 10 mg twice daily) or placebo for 6 weeks. Oxycodone was coformulated with naloxone to minimize constipation and thus to protect blinding of treatment allocatio…