{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T02:06:57Z","timestamp":1792980417975,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2019,3,5]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Consequences of prescription opioid use involve harms, addiction, tolerance and death. Despite routine prescription, opioids are not recommended for initial intervention by any major multidisciplinary low back pain (LBP) guideline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Our primary purpose was to improve overall understanding of the harms and benefits associated with oral opioid interventions prescribed for treatment of acute or chronic back pain. Our second goal was to evaluate pain intensity and to compare and contrast these data with the harms. Our last objective was to evaluate conflicts of interest among the study authors and the findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design\/data\/eligibility criteria<\/jats:title>\n                  <jats:p>Studies incorporating oral prescription opioid management of non-surgical LBP were evaluated. After systematic assessment, no studies that met inclusion included participants with specifically acute LBP. Therefore, extracted data reflects only populations with subacute and chronic LBP. Data on reported harms, severe harms, pain outcomes and withdrawal rates were extracted and meta-analyses were completed for opioid versus placebo trials and opioids versus non-opioid trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fourteen studies met inclusion\/exclusion requirements. All trials involved short-term management with limited follow-up. A high percentage of harms were identified across most studies. Opioids were not shown to be superior to other medications, and only showed superiority to placebo comparators (at cost of additional harms).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This review identified trends of higher harms rates and higher percentages of severe harms in opioid arms for the management of subacute and chronic LBP. The majority of trials that demonstrated benefits with opioids also had potential conflicts of interest. Lastly, non-opioid medications demonstrated statistically significant pain improvement compared with opioids. We feel that the results of the trial are supportive of current LBP guidelines and do not condone the initial use of opioids in management of subacute or chronic LBP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>CRD42017070914<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjsports-2018-099805","type":"journal-article","created":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T17:15:20Z","timestamp":1553274920000},"page":"664-664","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Harms and benefits of opioids for management of non-surgical acute and chronic low back pain: a systematic review"],"prefix":"10.1136","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6438-1189","authenticated-orcid":false,"given":"Hannah-Rose","family":"Tucker","sequence":"first","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Scaff","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess","family":"McCloud","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Carlomagno","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Daly","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Garcia","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8622-8361","authenticated-orcid":false,"given":"Chad E","family":"Cook","sequence":"additional","affiliation":[{"name":"Physical Therapy, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,3,22]]},"reference":[{"key":"2025080113084310000_54.11.664.1","doi-asserted-by":"crossref","first-page":"ES9","DOI":"10.36076\/ppj.2012\/15\/ES9","article-title":"Opioid epidemic in the United States","volume":"15","author":"Manchikanti","year":"2012","journal-title":"Pain Physician"},{"key":"2025080113084310000_54.11.664.2","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12875-015-0335-5","article-title":"Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study","volume":"16","author":"McCrorie","year":"2015","journal-title":"BMC Fam Pract"},{"key":"2025080113084310000_54.11.664.3","unstructured":"Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits: the DAWN Report. 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