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Conrad Notes
a timely medical meeting newsletter
OPIOID THERAPY FOR CHRONIC LOW BACK PAIN (LBP)
R. N. Jamison, PhD, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, compared naproxen (NP), oxycodone (OX) alone, and oxycodone plus controlled-release morphine (OXM) in 36 LBP patients. After four months' treatment, OXM patients reported less pain and emotional distress than the others. Overall, drug-related side effects occurred least frequently with NP dosing. Surprisingly, no differences were found on reported levels of activity among groups.
Pre-Study Demography The study included 36 LBP patients resistant to traditional pain medicines. After dropping opioid use, the pain scores ranged from 4 to 10 (mean, 6.8) on a scale of 0 to 10. Pain duration averaged 79.4 months (range, 9 to 312 months). Mean age was 42.6 years and ranged from 30 to 60 years. There were more females (57.1%) than males. About one-half of the patients received disability benefits and nearly one-fifth were employed.
Medication Schedule A one-month washout period preceded random assignment to one of three treatment groups:

  • naproxen (NP), 250 to 1000 mg twice daily

  • oxycodone (OX) set dose, 5 to 20 mg each day

  • oxycodone (OX) titrated dose and controlled-release morphine (M) up to 120 mg twice daily

Each LBP patient followed his/her assigned medication schedule for four months.

Efficacy Weekly telephone calls to each patient yielded information on: LBP severity, activity, mood, medication use, hours awake and adverse events. Efficacy highlights included:


Mean Values
Variable Scale NP OX OXM
Average Pain 0=none;100=worst poss. 64.8 62.5 52.6*
Anxiety 0=none;100=extreme 31.9 16.8 11.1*
Depression same 27.1 18.3 11.9*
Irritability same 33.6 21.2 19.3*
Activity 0=immobile,100=vigorous 51.3 48.3 47.3
Hours Awake - 18.1 18.3 18.3

*p=0.001

As seen above, there were significant treatment differences in average pain, anxiety, depression, and irritability but not in daily activity or hours awake.

Safety Weekly reported side effects totalled 812 over the four months. The NP group showed the fewest (190 or 23%), followed by OX- treated patients (309 or 38%) and OXM-medicated (313 or 39%). The most frequently reported side effects (dry mouth, drowsiness, headache, constipation, and nausea) occurred significantly less often in nonopioid (NP) patients. Because of the small number (11-13) of patients per treatment group, caution should be used in evaluating the efficacy and safety differences reported in this study.

For professional correspondence, please contact Dr. Jamison at: jamison@zeus.bwh.harvard.edu

Eugene A. Conrad

Presented at American Pain Society Meeting on 15 Nov 1996
CONRAD NOTES, © November 1996 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 26-Dec-1996

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