Opioids for chronic low-back pain
Bibliographic record
Abstract
BACKGROUND: The use of opioids in the long-term management of chronic low-back pain (LBP) appears to be increasing. Despite this trend, the benefits and risks of these medications remain unclear. OBJECTIVES: To determine the efficacy of opioids in adults with chronic LBP. SEARCH STRATEGY: We electronically searched CENTRAL, CINAHL and PsycINFO to May 2006; MEDLINE and EMBASE to May 2007. We supplemented our search by reviewing references in relevant systematic reviews and identified trials. SELECTION CRITERIA: We included randomized or quasi-randomized controlled trials assessing the use of opioids (as monotherapy or in combination with other therapies) for longer than four weeks, in adults with chronic LBP. Studies were included if they compared non-injectable opioids to other treatments. Comparisons between opioids were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality and extracted data onto a pre-designed form. Results were statistically pooled using RevMan 4.2. We reported on pain and function using standardized mean difference (SMD) with 95% confidence interval (95% CI) and on side effects using absolute risk difference (RD) with 95% CI. MAIN RESULTS: We included four trials. Three compared tramadol to placebo. Pooled results revealed that tramadol was more effective than placebo for pain relief, SMD 0.71 (95% CI 0.39 to 1.02), and improving function, SMD 0.17 (95% CI 0.04 to 0.30). The two most common side effects of tramadol were headaches, RD 9% (95% CI 6% to 12%) and nausea, RD 3% (95% CI 0% to 6%). One trial comparing opioids to another analgesic (naproxen) found opioids were statistically significant for relieving pain but not improving function. When re-calculated, the results were not statistically significant for either pain relief (SMD -0.58; 95% CI -1.42 to 0.26) or improving function (SMD -0.06; 95% CI -0.88 to 0.76) . AUTHORS' CONCLUSIONS: Despite concerns surrounding the use of opioids for long-term management of chronic LBP, there remain few high-quality trials assessing their efficacy. The trials in this review, although achieving high internal validity scores, were characterized by a lack of generalizability, inadequate description of study populations, poor intention-to treat analysis, and limited interpretation of functional improvement. Based on our results, the benefits of opioids in clinical practice for the long-term management of chronic LBP remains questionable. Therefore, further high-quality studies that more closely simulate clinical practice are needed to assess the usefulness, and potential risks, of opioids for individuals with chronic LBP.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.063 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.029 | 0.005 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.003 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.030 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".