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Feature Article

What is the evidence for opioid analgesia for low back pain?

Christina Abdel Shaheed, STEPHANIE MATHIESON, RICHARD O. DAY, CHRISTOPHER G. MAHER, ANDREW J. McLACHLAN, HANAN McLACHLAN, CHUNG-WEI CHRISTINE LIN

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Abstract

Opioid analgesics are commonly prescribed to treat low back pain. There is currently no evidence to support prescribing these medicines for people with acute low back pain, and only small pain relief is gained from opioid analgesics in people with chronic low back pain. Furthermore, concern is growing over adverse events and prescription opioid overdose and death.

Key Points

  • Low back pain clinical practice guidelines do not endorse the routine use of opioid analgesics.
  • Management of patients with acute and chronic low back pain should begin with reassurance and advice, including recommendation of appropriate nonpharmacological interventions.
  • If nonpharmacological pain relief is insufficient for patients with acute low back pain, then use pharmacotherapy such as NSAIDs.
  • If nonpharmacological pain relief is insufficient for patients with chronic low back pain, then pharmacological treatments such as NSAIDs or weak opioid analgesics (if the benefits outweigh the risks) may be considered.
  • For patients who have been on long-term opioid therapy and have had an inadequate response, consider opioid dose tapering and cessation.
  • There is moderate-quality evidence of a small benefit from opioid analgesics in managing chronic low back pain in the short term (less than three months after commencing).

    Picture credit: © Sebra/stock.adobe.com

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