A breakthrough Australian trial has highlighted the alternatives to highly addictive painkillers for treating severe back pain.
The trial saw the number of prescriptions for opioids issued to patients with acute back pain in emergency departments slashed without leading to increased pain levels for patients, the results published in the BMJ Quality and Safety journal on Thursday showed.
About 4500 patients took part in the randomised trial, which was conducted across four New South Wales emergency departments and led by researchers and clinicians from the Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District.
Across the four hospitals there was a 12 per cent decrease with opioid use, from 63 per cent to 51 per cent.
While the United States has been at the forefront of a global opioid epidemic that has resulted in mass addictions and overdoses, Australia has not been immune.
In Australia, the rate of opioid deaths rose by 62 per cent from 2007 to 2016, figures from the Australian Institute of Health and Welfare show.
About four million people or one in six Australians suffered from back problems in 2017-18 according to the AIHW.
The NSW trial results have the potential to transform the way back pain is treated at hospitals around the nation and help tackle the opioid crisis here and overseas.
“Every year thousands of Australians are unnecessarily being prescribed opioid painkillers which can cause addiction, overdose and in some cases even death,” lead researcher Gustavo Machado said.
Patients turn up at emergency departments “often in incredible pain and discomfort and receive a highly addictive painkiller,” Dr Machado said.
It’s meant to be just a short-term fix but in reality, a month later a third of patients are still taking these pills.”
The NSW trial involved training about 300 clinicians from Royal Prince Alfred, Canterbury, Concord and Dubbo hospitals in assessing, managing and referring patients with acute back pain without necessarily prescribing opioids, and providing alternatives including other medicines and heat wraps.
“Emergency departments are incredibly busy places and there is a huge pressure on clinicians to treat people as quickly as possible,” Dr Machado said.
Unfortunately, there is no easy fix for acute back pain but providing opioids has a lot of downsides.”
The trial has demonstrated “that there is a safer way to treat acute back pain that can easily be adopted by hospitals across the country,” Dr Machado said.
With back pain often being a leading reason people visit emergency departments, this new strategy could result in millions of scripts being handed out each year and help tackle the global opioid epidemic.”
Drop in opioid use doesn’t lead to increased pain levels
A dramatic fall in opioid use did not result in increased pain levels or any drop in satisfaction among patients, the trial showed.
At Canterbury Hospital opioid use fell from 61 per cent of patients being given prescriptions to 37 per cent over the four-month trial.
“Patients were happy; they were receiving better care in the emergency department; getting follow-up care if needed and there was an important drop in the amount of opioid painkillers used,” Canterbury Hospital director of medical services and senior emergency physician Eileen Rogan said.
Dr Rogan said physicians and nurses “embraced this trial because they could see the positive results almost immediately”.
“It’s clear there is a better model of care to help people with back pain, and one that does not rely so heavily on opioid painkillers,” she said.
Our main aim is to make people better, and alleviate their pain, not unwittingly place them on a path to addiction.”
Royal Prince Alfred Hospital head of rheumatology Bethan Richards said the trial “has significantly changed the way our staff both approach and manage people with back pain”.
“Clinicians have a greater understanding of the unseen harms that can come from prescribing opioids in emergency departments and a new confidence that using alternatives can deliver just as effective and much safer care,” Dr Richards said.