Opioids and Low Back Pain – Changing the Paradigm


A Rising Epidemic

With more than 30 percent of Americans experiencing an episode every year, it’s no surprise that low back pain is a leading reason for physician visits.

Too often, that visit results in an opioid prescription, leading to low back pain sufferers making up more than half of regular prescription opioid users. According to National Medical Expenditure Panel Survey (MEPS), opioid prescriptions for back pain have increased dramatically over the last 20 years, without a correlated decrease in the amount of pain reported.

This is problematic for two reasons.

The American Society of Addiction Medicine lists drug overdose as the leading cause of accidental death in 2015 and the Centers for Disease Prevention and Control (CDC) reports that opioid prescriptions are a driving factor in the 15-year increase in opioid overdose deaths, with deaths attributed to prescription opioids quadrupling since 1999. The link to heroin and other opioid abuse is also well documented, with over three quarters of abusers reporting their first opioid was prescribed. Even for adherent users, common opioid side effects can be unconducive to good quality of life.

Second, opioids have been clinically proven to be inefficacious for treatment of low back pain. They may temporarily mask pain but they do not expedite return to work or improve functional outcomes in acute low back pain, nor have they been shown effective in long-term management of chronic low back pain.

Evidence-Based Treatment of Low Back Pain

Last month, the American College of Physicians (ACP) issued a clinical practice guideline recommending doctors avoid opioids in the treatment of nonradicular low back pain and instead prescribe exercise, rehabilitation or alternative therapies. This guideline was issued based on an extensive review of peer-reviewed research, including randomized control trials and data from observational studies.

All stakeholders, including providers, healthcare payers and patients, benefit from care that follows treatment pathways grounded in evidence-based best practice. Unfortunately, current treatment practices for low back pain vary widely, often resulting in increased costs and failure to meet outcome goals.

In addition to the ACP recommendations, a body of clinical research exists to provide guidance in the development of evidence-based care pathways. Innovations in care delivery models and technology play an important role as they facilitate practical implementation of evidence-based care and connect stakeholders. We will be talking more about specific research and care delivery innovations in upcoming posts.

A Team Approach

We all have a stake in designing and demanding care that leverages the best that both science and technology offer in delivering value. The shift to a team-based approach has begun, with more patients demanding tools that facilitate active participation in their healthcare as well as insurers and employers increasingly embracing a leadership role as collaborative partners in the wellness of their members and employees.

Using evidence-based care to improve low back pain will result in significantly reduced opioid prescription, reductions in other ineffectual and costly treatment and, most importantly, better results.

Lydia Zeller is Kiio’s Director of Patient Engagement. She can be reached at lzeller@kiio.com.