The most common condition for which opioid analgesics are prescribed in the United States, and one of the most common reasons for a physician visit in general, is low back pain (LBP).

 

Nonspecific back pain affects approximately 30% of older adults at any given time. This patient group (65 years of age and over) often experience recurrent episodes of LBP as well. The prevalence of chronic LBP (cLBP) increased between 2000 and 2007 by 64% in the United States and similar increases have been noted globally. Spinal pain is also one of the costliest medical conditions, even though there was a decline in positive clinical outcomes between 1997 and 2006 despite rising costs. We (as taxpayers and/or private consumers of healthcare) are paying way more, for no real benefit or improvement!  

 

A recent study found that 31% of patients with LBP received prescriptions for opioid analgesics within the first 6 months of initial diagnosis, rising to 42% within 3 years. Nevertheless, the long-term effectiveness of opioid therapy for chronic LBP is unknown, whereas the risks of opioid analgesics are widely known and simply devastating on many levels. It has been reported that opioid analgesic therapy (OAT) results in 3.8% of patients developing opioid use disorder and up to 26% of patients developing opioid dependence. Furthermore, almost 70% of US drug overdose deaths in 2018 involved an opioid, resulting in 46,802 deaths from opioid-related overdoses. It is troubling that many patients who end up with negative clinical consequences from opioid medications were first prescribed these drugs for low back pain! Further, among patients with chronic, disabling musculoskeletal disorders, higher dosing of opioids is correlated with greater pain severity and higher levels of disability and depression.