Evidence statementsEvidence to recommendations
11.4.3.1.

One randomised controlled trial in people with low back pain of > 3 months duration found that oxymorphone extended release therapy was associated with a reduction in pain intensity compared with placebo. Incidences of opioid withdrawal after termination of therapy and adverse events were slightly higher in those randomised to receive oxymorphone compared with placebo.(1+) (Katz, Nathaniel., Rauck, Richard., Ahdieh, Harry. et al, 2007)

11.4.3.2.

One randomised controlled trial in people with low back pain of >6 months evaluated the safety and efficacy of tramadol extended-release compared to placebo once daily. Results showed that in patients who tolerated and obtained pain relief from tramadol, continuation of treatment for 12 weeks maintained pain relief more effectively than placebo. (1+) (Vorsanger, Gary. J., Xiang, Jim., Gana, Theophilus. J. et al, 2008)

11.4.3.3.

A randomised controlled trial in people with low back pain of > 6 months duration found that oxycodone therapy was associated with a reduction in pain intensity compared with placebo and improvements in the quality of analgesia, global assessment of study medication and in the physical component score of the Short Form 12-Question health survey compared with placebo. Incidence of physical dependence after termination of opioid therapy and of adverse events were higher in those randomised to receive oxycodone compared with placebo.(1+) (Webster, Lynn. R., Butera, Peter. G., Moran, Lauren. V. et al, 2006)

11.4.3.4.

No cost effectiveness studies found for opioid therapy

There is evidence available for short term use of oxymorphone.
One study supports use of Tramadol but this has higher cost.
Recommending long-term use of opioids was considered to be inappropriate as the evidence presented was all for short duration use.
No data were available to support use of weak opioids therefore the recommendation was made by consensus of the GDG.
Where paracetamol is insufficient, the positive effect of Opioids on QoL is considered to outweigh the QoL loss and costs due to side effects.
There is insufficient evidence to preferentially prescribe either opioids or preferentially prescribe NSAIDs for people who obtain insufficient benefit from paracetamol.

From: 11, Pharmacological therapies

Cover of Low Back Pain
Low Back Pain: Early Management of Persistent Non-specific Low Back Pain [Internet].
NICE Clinical Guidelines, No. 88.
National Collaborating Centre for Primary Care (UK).
Copyright © 2009, Royal College of General Practitioners.

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