Effects of long-term opioid and painkiller use for back pain

This article will discuss the use of opioids and painkillers prior to, or as a means to prevent or delay lumbar surgery.

What happens to people on long-term opioid therapy for back-specific disability?

An August 2022 study (1) wanted to assess what happens to people on long-term opioid therapy for back-specific disability and health-related quality of life in patients with chronic low back pain. In this study there were 96 long-term opioid users and 204 long-term opioid nonusers.

In surveying the people of this study, the researchers found:

  • Long-term opioid use (more than 12 months) was a predictor of worse back-specific disability, physical function, fatigue, participation in social role, and pain interference outcomes.
  • Intermediate-term opioid use was a predictor of worse back-specific disability, physical function, fatigue, and sleep disturbance outcomes.
  • Short-term opioid use was a predictor of worse back-specific disability and physical function outcomes.

The researchers concluded: “The findings of this study are largely consistent with existing literature regarding the outcomes of long-term opioid therapy. Taken in conjunction with the well-established risks of opioid medications, these findings draw into question the utility of long-term opioid therapy for chronic low back pain.”

Opioid-associated side effects can be distressing to some patients

A March 2022 paper (2) writes: “Pharmacological management for chronic low back pain must be suitable for long-term treatment. In a systematic review of 15 clinical trials (5,540 people) of low back pain patients, opioids were shown to be effective in the short term for reducing pain and somewhat effective for improving function compared to placebo in chronic low back pain patients . However, opioid-associated side effects can be distressing to some patients. Frequently reported opioid-associated side effects include nausea (8%), dizziness (8%), constipation (7%), vomiting (7%), somnolence (drowsiness) (6%), dry mouth (6%), and others ( less than 5%) including headache, pruritus (itchy skin), fatigue, anorexia, and hyperhidrosis (excessive sweating).

A November 2022 paper (3) examined opioid use for chronic pain prior to spinal surgery and the increased rate of post-operative adverse events in these patients. A subgroup of 2,112  patients using opioids preoperatively were followed. The researchers found “significantly higher incidence of infection compared to non-opioid users.” The researchers concluded: “Consistent with prior publications, opioid use was significantly associated with a higher incidence of two-year post-operative infection compared to non-use. Low-dose opioid users had higher post-operative infection rates than non-users.”

A May 2022 study (4) examined long-term spinal cord stimulation in patients with failed back surgery. At an average follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale (0-10) scale.



An April 2022 review study (5) examined the published research to suggest if opioids helped people with chronic low back pain. Here is what they wrote: “. . . existing uncertainties, controversies, and differing recommendations make the rationale for prolonged opioid use in chronic noncancer pain unclear.” The researchers of this study then  compared the efficacy, safety, and tolerability of strong opioids with placebo or nonopioid therapy in chronic noncancer pain, with a special focus on chronic low back pain. They did this by reviewing previously published research.  Very low to low certainty findings suggest that 4 to 15 weeks (short or intermediate term) opioid therapy in chronic low back pain (compared with placebo) may cause clinically relevant reductions in pain but also more gastrointestinal and nervous system adverse events, with likely no effect on disability. By contrast, long-term opioid therapy (more than 6 months) in chronic noncancer pain may not be superior to nonopioids in improving pain or disability or pain-related function but seems to be associated with more adverse events, opioid abuse or dependence, and possibly an increase in all-cause mortality.”


1 Schultz MJ, Licciardone JC. The effect of long-term opioid use on back-specific disability and health-related quality of life in patients with chronic low back pain. Journal of Osteopathic Medicine. 2022 Aug 11.
2 Orrillo E, Neira LV, Piedimonte F, Sanchez RP, Mihovilovic SA, Tamayo MA, Rekatsina M, Varrassi G. What Is New in the Clinical Management of Low Back Pain: A Narrative Review. Cureus. 2022 Mar 9;14(3).
3 Gonzalez GA, Corso K, Miao J, Rajappan SK, Porto G, Anandan M, O’Leary M, Wainwright J, Smit R, Hines K, Franco D. Does pre-operative opiate choice increase risk of post-operative infection and subsequent surgery?. World Neurosurgery. 2022 Nov 14.
4 Puylaert M, Nijs L, Buyse K, Vissers K, Vanelderen P, Nagels M, Daenekindt T, Weyns F, Mesotten D, Van Zundert J, Van Boxem K. Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome: A 20-Year Audit of a Single Center. Neuromodulation: Technology at the Neural Interface. 2022 May 14.
5 Nury E, Schmucker C, Nagavci B, Motschall E, Nitschke K, Schulte E, Wegwarth O, Meerpohl JJ. Efficacy and safety of strong opioids for chronic non-cancer pain and chronic low back pain: a systematic review and meta-analyses. PAIN. 2021 Aug 5.




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