What is the dosing for opioids in the management 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

With regard to opiod dosing, a study by Kobus et al [115] found that patients who received higher-dose (defined as at least 100 mg morphine or equivalent daily) had more mental health and medical comorbidities than patients treated with either lower doses of opiates or no opiates. The higher-dose patients also received more sedative hypnotic medications than the others. Though this is not a specific contraindication to prescribing narcotics at higher doses, it may be worthwhile to keep these results in mind.

In deciding the level of narcotics to prescribe, consider that the achievement of vocational, recreational, and social goals is a better measure of medication efficacy than subjective estimates of pain relief. [106] For chronic spinal pain, an ongoing, active, preferably independent exercise program aimed at functional restoration should be considered mandatory.


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