Pain is often the focus of patients with chronic low back problems. Finding a way to relieve the pain has become a major challenge for pain specialists. When there’s no cure for the condition, the goal is to improve function. One way to do that is to decrease the pain.
Treatment begins with anti-inflammatory and/or or analgesic (pain relieving) drugs. Exercise and physical activity are advised. When these measures don’t help, then spinal injections, opioid drugs, or surgery may be tried. In this article, doctors from the San Francisco Spine Institute in California and The Cleveland Clinic Center for Spine Health in Ohio review the place opioid analgesics have in managing chronic low back pain (CLBP).
Opioids are narcotic pain-relievers. They come in a wide range of forms from short-term to long-term and short-acting to sustained-release. Evidence for or against the use of these drugs has been lacking. Current studies have brought evidence that has given doctors a reason to re-think the use of opioids.
Information about average dose needed for good pain control is available now. Several safe and effective opioid analgesics are available for long-term use. Others have been developed to treat breakthrough pain. Opioids also come in different formulations now. Some are taken orally (pill form). Others come in patch form. The patch is changed every two to three days.
The authors provide a brief summary of many opioid analgesics useful for chronic pain. Duration of pain relief and special remarks about each one are reported. Some patients don’t respond to opioids. It appears that whether or not opioids are helpful may depend on the patient’s genetic predisposition. The prescribing physician must titrate the opioid for each patient. This means they find the optimal dose for each person based on symptoms and side effects.
Opioids work by binding to opioid receptors in the central nervous system. This makes it impossible for pain messages to get through from the body to the spinal cord and up to the brain. Concerns about dependence and addiction are important and should be taken into consideration.