Doctors Still Prescribe Opioid Painkillers For Back Pain Despite Guidelines

By Britni de la Cretaz 05/23/17

Guidelines suggest a host of opioid-free treatment options so many doctors are still heavily relying on opioids to treat back pain.

doctor passing a prescription to a patient.

A new poll from NPR and Truven Health Analytics has found that, against best practices recommendations, many doctors are still prescribing opioid painkillers for back pain.

Despite the fact that evidence-based practices suggest considering an array of treatment options before prescribing opioid painkillers—and despite the fact that opioid painkillers have not been shown to be particularly helpful with relieving back pain—doctors are still prescribing them at alarming rates. This is not helping patients’ symptoms and is putting them at risk for developing dependence or addiction, the poll finds.

The survey found that over half of respondents had experienced back pain in the previous year, and that most treated it themselves. Fifty-eight percent of respondents who suffered from back pain in the last 12 months indicated that they sought medical care. Among those experiencing such pain, 70% went to a medical doctor. The most frequently recommended treatment by a medical professional was prescription painkillers at 40%.

An analysis of over 20 studies on the efficacy of opioids on chronic lower back pain, published last year in the journal JAMA Internal Medicine, found that opioid pain medications can provide modest short-term pain relief, but that the effect “is not likely to be clinically important within guideline recommended doses.”

Earlier this year, the American College of Physicians (ACP) released new guidelines for treating back pain, based on the consensus that most back pain gets better over time. 

They suggest trying superficial heat, acupuncture, massage, and non-steroidal anti-inflammatory drugs or skeletal muscle relaxants as a first step. They next recommend that physicians suggest exercise, physical therapy, mindfulness-based stress reduction, yoga, tai chi, progressive relaxation, cognitive behavioral therapy, and a host of other treatment options.

If these are not effective, then opioid painkillers may be considered, says the ACP: “Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients.”

Despite these recommendations, it appears that doctors are still overwhelmingly recommending opioids as a treatment option for patients with back pain. This is also despite the fact that the overprescribing of opioids has been shown to have played a major role in the nation’s current opioid epidemic and the climbing rate of overdose deaths.

According to the Centers For Disease Control and Prevention (CDC), the amount of prescription opioids sold in the United States has nearly quadrupled, as have deaths from the drugs—yet there has not been an overall change in the amount of pain that Americans report.

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Britni de la Cretaz is a freelance writer, baseball enthusiast, and recovered alcoholic living in Boston. Follow her on Twitter at @britnidlc.