ArticleSpine2014
Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review.
Article in Spine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
89 citing papers in PubMed, 6 syntheses or guidelines pooled it, 271 citations in OpenAlex.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- A review of trial and real-world data applying elements of a realist approach to identify behavioural mechanisms supporting practitioners to taper opioids.British journal of clinical pharmacology · 2022Pooled it
- Impact of contextual factors on patient outcomes following conservative low back pain treatment: systematic review.Chiropractic & manual therapies · 2022Pooled it
- Effect of Brace to Osteoporotic Vertebral Fracture: a Meta-Analysis.Journal of Korean medical science · 2016Pooled it
- [Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy - a systematic literature review].Der Orthopade · 2016Pooled it
- Guideline
- Central Nervous System Polypharmacy Among People Living With Dementia.Journal of the American Medical Directors Association · 2025Trial
- Opioid Exposure Negatively Affects Antidepressant Response to Venlafaxine in Older Adults with Chronic Low Back Pain and Depression.Pain medicine (Malden, Mass.) · 2020Trial
- Population Pharmacokinetic/Pharmacodynamic Modeling of O-Desmethyltramadol in Young and Elderly Healthy Volunteers.Drugs & aging · 2019Trial
- Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials.Yonsei medical journal · 2017Trial
- Trial
- Pharmacological management of chronic low back pain in older patients: a randomized controlled trial of the effect of pregabalin and opioid administration.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2015Trial
- French National Guidelines for the Appropriate Use of Opioids: Analgesia, Opioid Use Disorder, and Overdose Prevention-Part 1: Methodology and Pain Management.Pain and therapy · 2026Article
- Difficulties with prescribed opioids: a cross-sectional survey of primary care patients in England, United Kingdom.Pain reports · 2025Article
- Pharmacological interventions for patients with chronic primary musculoskeletal pain: disparity between synthesized evidence and real-world clinical practice.Pain reports · 2025Article
- Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon.Journal of general internal medicine · 2025Article
- Benchmarks for low back pain in general practice in Flanders: electronic audit of INTEGO.BMC primary care · 2024Article
- Article
- Validity of central pain processing biomarkers for predicting the occurrence of oncological chronic pain: a study protocol.BMC cancer · 2024Article
- Increased Use and Large Variation in Strong Opioids and Metamizole (Dipyrone) for Minor and Major Musculoskeletal Injuries Between 2008 and 2018: An Analysis of a Representative Sample of Swiss Workers.Journal of occupational rehabilitation · 2024Article
29 more citing papers are in PubMed but not listed here.
Corrections and comments
- Reprint of
Authors and funding
6 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
designSystematic review and meta-analysis.
objectiveTo assess the efficacy of opioids in adults with chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA: Opioids for CLBP has increased dramatically. However, the benefits and risks remain unclear.
methodsWe updated a 2007 Cochrane Review through October 2012 of randomized controlled trials from multiple databases. Use of noninjectable opioids in CLBP for at least 4 weeks was compared with placebo or other treatments; comparisons with different opioids were excluded. Outcomes included pain and function using standardized mean difference (SMD) or risk ratios with 95% confidence intervals (CIs), and absolute risk difference with 95% CI for adverse effects. Study quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria.
resultsFifteen trials (5540 participants), including twelve new, met the criteria. Tramadol was better than placebo for pain (SMD, -0.55; 95% CI, -0.66 to -0.44) and function (SMD, -0.18; 95% CI, -0.29 to -0.07). Compared with placebo, transdermal buprenorphine decreased pain (SMD, -2.47; 95% CI, -2.69 to -2.25), but not function (SMD, -0.14; 95% CI, -0.53 to 0.25). Strong opioids (morphine, hydromorphone, oxycodone, oxymorphone, and tapentadol), were better than placebo for pain (SMD, -0.43; 95% CI, -0.52 to -0.33) and function (SMD, -0.26; 95% CI, -0.37 to -0.15). One trial demonstrated little difference with tramadol compared with celecoxib for pain relief. Two trials (272 participants) found no difference between opioids and antidepressants for pain or function. Reviewed trials had low to moderate quality, high drop-out rates, short duration, and limited interpretability of functional improvement. No serious adverse effects, risks (addiction or overdose), or complications (sleep apnea, opioid-induced hyperalgesia, hypogonadism) were reported.
conclusionThere is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat CLBP compared with placebo. The effectiveness and safety of long-term opioid therapy for treatment of CLBP remains unproven.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.