What is the efficacy of opioids for the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

However, from a practical standpoint, low to moderate doses of opioids may be helpful for activating an injured patient to participate in physical and psychological rehabilitation, including functional restoration, especially with patients whose pain is associated with acute radiculopathy, particularly in those cases that are pre- or postoperative. Opioid analgesics may be helpful for sufferers of chronic intermittent back pain during an acute exacerbation; however, the continuous use of opioid analgesics for chronic neck and back pain is usually reserved as a tertiary treatment option.

Over the past decade, physicians, specifically pain specialists, have adopted a greater willingness to prescribe opioid analgesics for the treatment of refractory spinal pain and radiculopathy. Most patients reclaim what life they can. Inherent dangers include side effects such as respiratory depression cardiac toxicity, bowel dysfunction, sometimes paralysis or obstruction, and hormonal suppression, especially of testosterone, as well as addiction, naive withdrawal, and death from overdosage. The side effect profiles among long-acting opioids are similar, but the cost is variable between current pharmaceutical offerings, which include orally routed methadone, long-acting oxycodone, long-acting morphine, long-acting oxymorphone, and the controlled deliveryof fentanyl by transdermal patch.

Several principles apply to prescribing long-acting opioids for chronic pain. These medications should be taken in a time-contingent, rather than pain-contingent manner, and they should only be provided by one prescribing physician and pharmacy. The need and purpose of the opioids and their medical necessity should be affirmed by an agreement signed by both patient and doctor and placed in the medical record.


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