Although opioids may be an option for carefully selected patients treating many different kinds of back pain, they also have the potential for adverse effects, including cognitive, gastrointestinal and other organ-related side issues. Additionally, risks include misuse, abuse, and addiction. The increase in opioid prescribing for chronic pain has paralleled the increase in patients—and people with substance abuse problems—developing opioid addiction including opioid use disorder (OUD).1

See Opioid Medication Potential Risks and Complications

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The article will review:

  • Existing recommendations for using opioids to treat back pain
  • Definitions of physical dependence, addiction, and opioid use disorder
  • Office tools that may help clinicians assess for risk factors for aberrant behaviors, and the signs and symptoms of problematic use, including abuse, misuse, and opioid addiction in patients prescribed opioid medications for chronic pain management
  • Opioid detoxification and withdrawal
  • Medication assisted treatment (MAT), including a description of medications used to treat opioid use disorder
  • Various treatment options for people with substance use or opioid use disorder, including people living with chronic pain

Opioids and Back Pain

Opioids are powerful analgesic medications that may be prescribed as part of a medication regimen for chronic pain conditions including spine related neck and back pain. Opioids may be used to treat:

  • Postsurgical acute pain, such as back surgery
  • Pain from an acute injury, such as a spine injury that results in a nerve compression, including radiculopathy, vertebral compression fractures, disc or facet injuries
  • Chronic back pain, if other treatment options have been exhausted

See Narcotic Pain Medications

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Concerns regarding the potential for addiction, misuse, abuse, and other adverse effects have led a reduction in opioid prescriptions. This does not mean medication will be unavailable to a person who needs it, but that there is increased monitoring and stricter prescribing guidelines. According to the CDC:

“Nonpharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.”2

Even with stricter prescribing guidelines, the potential for opioid abuse exists. How do doctors and patients know when opioid use has become problematic? The differences between physical dependence and addiction are described on the next page.

References:

  1. Sullivan MD, Edlund MJ, Fan MY, et al. Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and Medicaid insurance plans: the TROUP study. Pain. 2010;150:332-339
  2. Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention (CDC); 2017. https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf. August 29, 2017. September 26, 2018.
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