Are Opioids the Most Powerful Pain Reliever for Low Back Pain?

Jul 04, 2017

Opioids, or narcotic pain medications, are commonly thought of as powerful pain relievers. Patients frequently request them and healthcare providers often prescribe them for back pain because they think that opioids are the most effective pain reliving treatment. Popular media and others in society also commonly think that without opioids patients will suffer intolerable or “intractable” back pain. The implication is that, again, opioids are the most powerful and effective pain reliever.

But are they the most effective pain relieving treatment for back pain?

 The American College of Physicians (Qaseem, et al., 2017) recently published guidelines for the treatment of acute low back pain (i.e., back pain lasting less than three months) and chronic low back pain (i.e., pain lasting longer than three months). Experts in the field of low back pain from within their group developed the guidelines. The experts reviewed all the available scientific evidence on what works and what doesn’t work for low back pain. Specifically, they reviewed the evidence for the effectiveness of medications and non-medication therapies, with the exception of surgeries and other interventional procedures, such as spinal injections.

Here’s what they found:

  • Many therapies have more evidence in support of their effectiveness than opioids
  • A number of non-medication therapies were more effective than any medication, including opioids
  • For low back pain lasting less than three months long (i.e., acute low back pain), the therapies that have more evidence to support their effectiveness are anti-inflammatory medications, heat, exercise, spinal manipulation (i.e., chiropractic) and possibly acupuncture
  • For low back pain lasting longer than three months (i.e., chronic low back pain), these therapies are largely considered to be more effective than opioid pain medications: interdisciplinary pain rehabilitation programs, cognitive behavioral therapy, exercise, mindfulness based stress reduction, and to a lesser extent acupuncture, tai chi, and yoga.
  • Of the medications used for chronic low back pain, anti-inflammatories and duloxetine have greater support for their effectiveness than opioid medications.
  • Opioid pain medications, while having less scientific evidence supporting their effectiveness, were associated with increased risk of harm, including addiction and death.

Perhaps it’s time to start dispelling the myth that opioid pain medications are always the most effective pain relieving treatment. There are conditions, like low back pain, for which other treatments are more effective. On top of it all, these more effective treatments aren’t associated with high rates of addiction and death.

References

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530.

 

Author: Murray J. McAllister, PsyD

Date of last modification: July 5, 2017

About the author: Dr. McAllister is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides scientifically accurate information on chronic pain that is approachable to patients and their families.

Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis. 

The views contained in this post are solely those of the author and do not represent Courage Kenny Rehabilitation Institute or Allina Health.

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