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Study: Don't Avoid Opioids to Treat Back Pain

Drugs are sometimes abused, but they have great benefits

THURSDAY, Oct. 3, 2002 (HealthDayNews) -- Doctors and pharmacists tend to avoid prescribing them, patients are afraid of becoming addicted to them, and government officials are concerned about their abuse. It's little wonder that opioids have acquired something of an unsavory reputation in medicine.

But is it all deserved?

A new study suggests it's a mistake to ignore the potential value of these powerful pain relievers for chronic conditions, including musculoskeletal pain and lower back pain.

There's evidence that opioids such as morphine, oxycodone, and fentanyl can help and should be the treatment of choice for some patients, says Dr. J.D. Bartleson, a Mayo Clinic neurologist and lead author of the study. It appears in the latest issue of the journal Pain Medicine.

"The prejudice against the use of analgesic opioids is unfortunate," Bartleson explains. "Especially since it results in their being underutilized in situations where they can contribute to improving patient outcomes. Opioids can provide significant relief for patients experiencing severe pain. I believe physicians and patients should be considering them more often than they presently do, including use in the management of chronic, nonmalignant pain."

Bartleson bases his conclusion on extensive analysis of all studies of opioid use in the treatment of chronic lower back pain. Despite longstanding controversies over opioid misuse and potential dependence, Bartleson found there is a place for their carefully considered and closely monitored use in treating this persistent, debilitating condition. In particular, he says, opioid use may provide a better alternative than back surgery and other pain medications for many patients whose lower back pain is persistent.

"Fewer than half of all back surgeries are successful in relieving chronic back pain," Bartleson says. "Other medicines for pain -- including aspirin and acetaminophen -- can cause permanent adverse effects. Opioids have been demonstrated to provide pain relief, without long-term side effects."

John Giglio, executive director of the American Pain Foundation, concurs. He adds the recent controversy over the opioid OxyContin has further muddied the waters over the benefits of this entire class of prescription medications.

"There is mounting evidence that physicians are being deterred from using opioid drugs for patients in pain, not only because of the bad publicity about certain ones of these medications, but also because they are concerned they will be investigated by the U.S. Drug Enforcement Agency if they prescribe them," Giglio says. "Even where there is no arrest, no indictment, no evidence of physician or pharmacist wrongdoing, an investigation sends a strong negative ripple through the medical community."

Giglio says chronic back pain is only one of the conditions for which negative publicity has overshadowed opioids' legitimate and proven medical benefit. Even in the treatment of serious malignant conditions, doctors and patients tend to shy away from the powerful drugs.

"In a recent survey of cancer specialists in California, for example, only about 60 percent of the oncologists reported being certified to prescribe opioids," Giglio says. "Of these, only 40 percent had ever done so -- which means that only one in four physicians specializing in cancer treatment in California are presently using the most powerful painkillers available in their practice."

Giglio and Bartleson agree that additional, longer-term and better-designed studies are needed to study how opioids can be best used in medical care.

Although Bartleson now counts himself among believers in opioids' benefits in the treatment of chronic back pain, he doesn't advocate their use for every back pain patient. "Opioids definitely have a role to play," Bartleson says. "But a physician has to make sure that whatever treatment is pursued is the best for the individual patient. Opioids aren't for everyone."

Bartleson adds that, more than anything else, his study points out the need for additional well-designed studies on treating back pain, including the role opioids can legitimately play in such treatment.

What To Do

Learn more about policies governing opioid use in the United States from the Pain Policy Study Group at the University of Wisconsin. The American Pain Foundation advocates for those who hurt.

SOURCES: J.D. Bartleson, M.D., neurologist, Mayo Clinic, Rochester, Minn.; John Giglio, executive director, American Pain Foundation, Baltimore; September 2002 Pain Medicine
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