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Invited Commentary
Health Policy
June 22, 2018

Opioid Prescribing for Low Back Pain: What Is the Role of Payers?

Author Affiliations
  • 1Section of Plastic Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor
  • 2Department of Anesthesia, Michigan Medicine, University of Michigan, Ann Arbor
JAMA Netw Open. 2018;1(2):e180236. doi:10.1001/jamanetworkopen.2018.0236

Low back pain is one of the leading causes of disability and chronic pain among adults and one of the most common reasons for which patients are treated with opioids. However, there is growing evidence that opioid analgesics are not superior to nonopioid treatment strategies for low back pain.1,2 Recent data from the first randomized clinical trial with long-term outcomes1 demonstrated that opioid treatment did not confer benefit with respect to pain-related function and that adverse medication-related events were more common among patients receiving opioid therapy. In contrast, pain intensity was improved among patients randomized to nonopioid treatment.1 Although opioids provide effective analgesia for acute pain, their initiation for the management of chronic pain remains problematic. For chronic pain, long-term opioid therapy is associated with poorer patient-reported pain, function, and quality-of-life outcomes and may be less effective among individuals with mood disorders, centralized pain syndromes, neuropathic pain, and psychiatric disorders.3,4 Opioid therapy is also associated with numerous dose-related adverse effects, such as respiratory depression and overdose, as well as dependence, tolerance, worsened pain, depression, constipation, and confusion.5 Approximately 20% of individuals receiving long-term opioid therapy develop an opioid use disorder.6 Therefore, given the prevalence of chronic low back pain in the United States, identifying effective nonopioid alternatives for chronic low back pain is a top health care priority.

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