A recent trial in Sydney has resulted in a significant reduction of the number of opioids used in emergency rooms for lower back pain.
Two-thirds of Australians who end up in emergency departments with lower back pain are given opioids. In the US, opioids are administered to approximately 40% of lower-back pain patients in emergency rooms.
Opioids are a group of pain-relieving drugs that works by blocking pain messages between the body and the brain and include morphine, oxycodone, fentanyl and methadone.
While they can be effective at treating severe pain, they are also highly addictive and have many adverse side effects such as nausea, dizziness and fatigue. In some cases, they can cause death by slowing down breathing and heart rates.
There is also a danger that a person using opioids for pain management may develop a tolerance for the drug, meaning they require a higher dose to feel the same pain relief.
“When we showed the data to the emergency department directors, they agreed that the rates were too high, and we needed to do something about the problem,” says Professor Chris Maher, Director of the Institute for Musculoskeletal Health at The University of Sydney.
The Australian trial reduced opioid use from 62.8% to 50.5% of cases without any negative impact on reported patient outcomes such as pain intensity, quality of life, and care satisfaction.
“Despite this progress, there is still a lot of work to be done in improving low back pain management, as it remains a major global burden,” lead author of the study, Claudia Côté-Picard, from the Center for Interdisciplinary Research in Rehabilitation and Social Integration at Laval University in Canada, told Cosmos by email.
“Nonetheless, I think it is promising to see that an intervention aimed at encouraging emergency department clinicians to adhere to low back pain guidelines resulted in a decrease in the use of opioid pain medicines.”
In reducing the number of opioids administered, there was a fear that doctors may turn to risky alternatives such as benzodiazepines or antiepileptics.
However, the researchers found there was no evidence of this happening. In fact, benzodiazepine use also decreased throughout the trial.
Instead, the researchers found that across the trial prescriptions for paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, increased.
“We have a responsibility to care for patients and treat them respectfully,” says Maher.
“The great thing about this trial is that we had great buy-in from the front-line clinicians in emergency department.
“Reducing use of opioids will lower back pain patients’ risk of serious harms such as dependence, overdose and death. But it is important to say that you need to provide the safer alternatives to opioids so that patients get good pain control.
“Changing behaviour is of course hard.
“But we have already had other hospitals in Australia and overseas reach out to us to help them roll out similar initiatives in their emergency departments. Overuse of opioid pain medicines is a global health issue.”