Background: Acute low back pain (ALBP) is a common clinical complaint that can last
anywhere from 24 hours to 12 weeks. In recent years, there has been an opioid epidemic
which is linked to the increased availability of prescription opioids. Though guidelines
recommend that in the treatment of ALBP, opioids should be used when other treatments
fail, we have seen an increase in opioid prescriptions for ALBP. With this crisis, it is important
to examine if there are any adverse outcomes associated with prescribing opioids for ALBP.
Objective: We aim to review the published literature to examine the adverse outcomes
associated with opioid use for ALBP.
Study Design: We performed a systematic review with meta-analysis in accordance
with our published protocol and PRISMA guidelines.
Setting: The review was conducted at McMaster University.
Methods: Various electronic databases for articles published from inception to September
30, 2017, inclusive. Both randomized clinical trials and observational studies on the impact
of opioid use in ALBP in the adult population were included. Eight pairs of independent
reviewers performed screening, data extraction, and assessment of methodological
quality. The identified articles were assessed for risk of bias using sensitivity analysis. Trials
with comparative outcomes were reported in a meta-analysis using a fixed effects model.
Results: A total of 13,889 studies were initially screened for the review and a total of
4 studies were included in the full review, of which 2 studies were meta-analyzed. Our
results showed that prescribing opioids for ALBP was significantly associated with longterm continued opioid use (1.57, 95% CI, 1.06-2.33). There was no significant association
found between unemployment duration and prescribing opioids for ALBP (3.54, 95% CI,
-7.57 to 14.66).
Limitations: Due to the limited number of studies that considered unemployment,
only an unpooled analysis was conducted. Among the included studies there was both
statistical and clinical heterogeneity due to differences in methodology, study design, risk
of selection or performance bias. Most of the studies had an unclear or high risk of bias
and poorly defined side effects.
Conclusions: Due to the lack of literature examining long-term adverse outcomes
associated with prescribing opioids for ALBP, no definitive conclusions can be made.
However, with the literature available, there does seem to be risk associated with
prescribing opioids for ALBP so there is a great need to conduct further investigations
examining these adverse outcomes for ALBP patients.
Key words: Acute low back pain, opioids, prescriptions, low back pain, long-term use,
opioid use disorder
Acupuncture for Acute Low Back Pain: A Network Meta-Analysis