Opioids for chronic low back pain management: a Bayesian network meta-analysis

ABSTRACT

Introduction: Chronic low back pain (LBP) is common, and some patients require opiates therapy. This Bayesian network meta-analysis (NMA) analyzed available randomized clinical trials (RCTs) on the use of opioids for LBP.

Methods: All RCTs comparing two or more opioids for chronic LBP and reporting results under the Numeric Rating Scale were included. The following drugs were analyzed: fentanyl, morphine, tapentadol, oxycodone, buprenorphine, oxymorphone, tramadol. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis, with standardized mean difference (SMD) effect measure. Data regarding the rate of adverse events and different drug formulations were also reported.

Results: Data from 2933 patients were obtained, with a mean age of 53.30 ± 6.95 years. The mean duration of symptoms prior to beginning the trial was 95.16 ± 47.29 months. The mean follow-up was 3.29 ± 1.72 months. Among the analyzed compounds, oxymorphone, tapentadol and fentanyl showed the highest efficacy in terms of pain reduction.

Conclusion: According to published level I evidence, oxymorphone, tapentadol and fentanyl were the most effective drugs in the treatment of chronic LBP. However, different formulation and pharmacokinetic characteristics need to be taken into consideration when choosing the ideal compound for a given patient.

KEYWORDS:

• Spine
• low back pain
• chronic
• pharmacologic treatment
• opiates

Article highlights

• Exercise and multidisciplinary rehabilitation are recommended as a first-line therapy for chronic low back pain, followed by therapy with non-steroid antiinflammatory drugs. In the cases in which these options are ineffective, opiates can provide a further alternative.

• In our analyses, oxymorphone, tapentadol, and fentanyl are the most effective compounds in the treatment of chronic low back pain.

• Formulation and adverse events require consideration when initiating opioid therapy, to provide the patient with a medication that is tailored on specific requirements and presence of comorbidities.

Acknowledgments

Valentin Quack and Alice Baroncini contributed equally to the study.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.