Chronic Lower Back Pain - Opioid Therapy With (Oxycontin(R)/Oxygesic(R) Tablets), Plus Modified Approach Provides Superior Rehabilitation

Main Category: Back Pain
Article Date: 24 Aug 2005 - 6:00 PDT

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Sydney, Australia - New data, announced today at the 11th IASP World Congress of Pain, in Sydney, Australia, reveals over half (55%) of lower back pain patients treated with the controlled release opioid oxycodone (OxyContin(R)/Oxygesic(R)) tablets, in conjunction with a comprehensive rehabilitation programme, reported a 'return to normal' or a 'strong improvement' in their ability to work, compared to only 17% of patients receiving conventional therapy including other pain medications1. Today's paineurope newswire focuses on this exciting new announcement, providing details of the study and its implications for clinical practice.

In Germany, multidisciplinary rehabilitation programs form an important part of the rehabilitation of patients with chronic low back pain (CLBP), working towards alleviating the pain suffered by the patient and allowing their lives to return to normal or near normal levels.

The study team from Nurenberg, Germany, undertook a controlled, prospective, open 'with and without' study in three rehabilitation centres in Germany to determine how the opioid oxycodone affected the outcome of patients with CLBP.

A total of 443 patients with CLBP were entered in the study
Of these:

- 154 patients received 'conventional therapy' in line with the normal procedures for the multidisciplinary rehabilitation programs
- 289 patients received 'modified therapy', which incorporated oxycodone (mean dose 31.2+/-13.2mg/d).

Selection criteria:

- Age: greater than or equal to 18 years (mean age 50.3+/-11.2 years).

- Diagnosis of CLBP with a mean daily VAS of greater than or equal to 50mm (moderate to severe pain). Pain intensity was comparable between the groups at the beginning of rehabilitation.

"Effective analgesia is of paramount importance in multidisciplinary rehabilitation programs for patients with chronic lower back pain" explained Dr Michael Ueberall, Institute of Neurological Sciences, Nuernberg, Germany. "The effectiveness of the analgesia produced by oxycodone in the modified therapy group is evident from the significant improvements in outcome. In particular, the fact that more than half the patients stated that they did not feel a significant constraint on their physical therapy and that there was a strong improvement or a return to normal in their employability."

All of the patients studied had previously received non-opioid analgesics for the treatment of the CLBP. WHO step II analgesics such as tramadol had been used in 40.3% of the conventional therapy group and 43.6% of the modified therapy group. WHO step III analgesics had been used in 29.9% of the conventional therapy group and 28.4% of the modified therapy group. Adjuvant analgesia such as antidepressants and anticonvulsants had been used in 41.6% and 39.8% of the conventional and modified therapy groups, respectively. However, despite this previous analgesia, more than 50% of all CLBP patients had experienced pain for more than three years.

Disability and quality of life measures were comparable between the conventional and modified therapy groups at the beginning of the study, with two-thirds of patients having been unable to work for 'some months' or 'some years'. More than 80% of patients reported that their pain had caused 'noticeable' to 'total' constraints on their activities, requirements or needs, and almost all of the patients felt that they could only influence their pain 'a little bit', or 'not at all'.

The use of oxycodone in the modified therapy group showed significant improvements in all parameters when compared to the outcomes of the conventional therapy group after the rehabilitation programme. 61% of the modified therapy group stated that the degree of pain reduction was a 'strong reduction' or 'pain free' compared with 34% of the conventional therapy group.

58% of modified therapy patients reported 'no' or 'slight' constraint on physical therapy compared with 25% of the conventional therapy patients.

While both groups showed improvement in constraints to patient activities, requirements or needs, 39.4% of the modified therapy group reported that the constraint was 'nothing at all' compared with only 11.7% of patients in the conventional therapy group (see figure 4). This corresponds to an increase of 38% and 9.1% in the modified and conventional therapy groups, respectively.

67% of patients in the modified therapy group felt that their influence on the pain was now 'strong' or 'total'. This compares with only 8% of the conventional therapy group.

hen questioned about their degree of working ability after the three-week rehabilitation program, 55% of the modified therapy group stated that there was a 'strong improvement' or a 'return to normal' compared with only 17% in the conventional therapy patients.

Of additional note, neither group experienced significant cognitive deficit as a result of their therapy.

Results from the study clearly reveal that effective analgesia is of paramount importance in multidisciplinary rehabilitation programs for patients with CLBP. Without this analgesia, patients are unable to undertake the physiotherapy necessary, expectations of success remain low and outcomes are poor.

The effectiveness of the analgesia produced by oxycodone in the modified therapy group is especially evident from the significant improvements in outcome. Of particular relevance, more than half of the patients stated that they did not feel a significant constraint on their physical therapy and that there was a strong improvement or a return to normal in their employability.

Transferring the relevance of the study to a real world setting, the cost of long-term treatment of CLBP patients is significant, particularly as a poor outcome can result in the extension of the multidisciplinary rehabilitation program. In this study the use of oxycodone resulted in a program extension in only 27.3% of patients, compared with 46.8% of those patients included in the conventional therapy group. Therefore, the use of a modified therapy equates to a cost saving of 41.7%.

"Under-treatment of chronic pain remains a significant global socio-economic burden. To alleviate the suffering experienced by patients, it is vital that multidisciplinary programmes, supplemented by effective opioid therapy, are put into place to address psychological, social, occupational, physical and pharmacological aspects", explained Dr Gerhard Muller-Schwefe, of Neurological Sciences, Nuernberg, Germany. "The results of this study show that effective analgesia with oxycodone plays a significant role in relieving the burden of chronic lower back pain. As such, improved education in the use of opioids is essential to ensure effective management of pain for all patients".

What are Opioids?

For more information on what opioids are, and opioid-induced constipation (OIC), please see:
All About Opioids and Opioid-Induced Constipation (OIC)

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