Don’t use an opioid analgesic medication as first-line treatment for acute, uncomplicated, mechanical, back-dominant pain.

Over 90% of acute low back pain is a mechanical problem that is often self-limiting and can be controlled with physical treatment and non-narcotic medication. The most common entry point to prescription opioid addiction is through opioids prescribed for back pain. Adequate pain control using opioids is frequently not achieved and patients face the added risks of physical dependence and withdrawal hyperalgesia, which can lead to continued use.

 

Sources:

Deyo RA, et al. Opioids for low back pain. BMJ. 2015 Jan 5;350:g6380. PMID: 25561513.

Hooten WM, et al. Opioid-induced hyperalgesia in community-dwelling adults with chronic pain. Pain. 2015 Jun;156(6):1145-52. PMID: 25815431.

Webster BS, et al. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine (Phila Pa 1976). 2007 Sep 1;32(19):2127-32. PMID: 17762815.

Younger J, et al. Reduced cold pain tolerance in chronic pain patients following opioid detoxification. Pain Med. 2008 Nov;9(8):1158-63. PMID: 18564998.