Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction

Ann Intern Med. 2007 Jan 16;146(2):116-27. doi: 10.7326/0003-4819-146-2-200701160-00006.


Background: The prevalence, efficacy, and risk for addiction for persons receiving opioids for chronic back pain are unclear.

Purpose: To determine the prevalence of opioid treatment, whether opioid medications are effective, and the prevalence of substance use disorders among patients receiving opioid medications for chronic back pain.

Data sources: English-language studies from MEDLINE (1966-March 2005), EMBASE (1966-March 2005), Cochrane Central Register of Controlled Clinical Trials (to 4th quarter 2004), PsychInfo (1966-March 2005), and retrieved references.

Study selection: Articles that studied an adult, nonobstetric sample; used oral, topical, or transdermal opioids; and focused on treatment for chronic back pain.

Data extraction: Two investigators independently extracted data and determined study quality.

Data synthesis: Opioid prescribing varied by treatment setting (range, 3% to 66%). Meta-analysis of the 4 studies assessing the efficacy of opioids compared with placebo or a nonopioid control did not show reduced pain with opioids (g, -0.199 composite standardized mean difference [95% CI, -0.49 to 0.11]; P = 0.136). Meta-analysis of the 5 studies directly comparing the efficacy of different opioids demonstrated a nonsignificant reduction in pain from baseline (g, -0.93 composite standardized mean difference [CI, -1.89 to -0.03]; P = 0.055). The prevalence of lifetime substance use disorders ranged from 36% to 56%, and the estimates of the prevalence of current substance use disorders were as high as 43%. Aberrant medication-taking behaviors ranged from 5% to 24%.

Limitations: Retrieval and publication biases and poor study quality. No trial evaluating the efficacy of opioids was longer than 16 weeks.

Conclusions: Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term pain relief. Long-term efficacy (> or =16 weeks) is unclear. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases.

Publication types

  • Meta-Analysis
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Chronic Disease
  • Clinical Trials as Topic / standards
  • Drug Prescriptions / statistics & numerical data*
  • Humans
  • Low Back Pain / drug therapy*
  • Low Back Pain / epidemiology
  • Prevalence
  • Substance-Related Disorders / epidemiology*
  • United States / epidemiology


  • Analgesics, Opioid