No More Opioids for Back Pain?

One in four adults report lower-back pain in the last three months.  In a paper published today (February 14, 2017) in the Annals of Internal Medicine, the American College of Physicians recommends that patients avoid prescription and even non-prescription medications as a first effort to treat lower-back pain.  Since "most patients with acute back pain improve over time, regardless of treatment", the paper recommends that patients who want to treat their pain use a heating pad and potentially seek acupuncture or a chiropractor.

This is just the latest effort on the part of the medical community to try to steer doctors and patients away from prescription opioids.  Now that evidence clearly shows that an over-prescription of opioids has lead to the epidemic of opioid addiction and overdoses, there are more and more calls to reduce prescriptions.

Some of the efforts are coming from the Government, as one of our previous blog posts highlights.  But more and more, the medical community itself is highlighting over-prescription within its ranks or counseling physicians to pause before initiating any new prescriptions of opioids.  

In a paper published last week in the American College of Obstetricians and Gynecologists, Jarlenski, et al, reveal that more than 12% of all healthy vaginal births of medicaid patients in Pennsylvania were prescribed opioids within five days of delivery.  Of those, 14% filled a second prescription within sixty days of delivery.   The authors excluded women who were previously diagnosed with opioid use disorder, so these are all seemingly naive users prescribed opioids as as a result of child birth.   The conclusion of the paper is that clear recommendations for opioid prescriptions after child birth are necessary.

Since we know that the most common path to opioid addiction begins with prescriptions from a doctor, slowing down the rate of opioid prescriptions is critical to fighting the opioid epidemic. The recommendations surrounding back pain are likely only the beginning of efforts from the medical community to re-orient patients and doctors around the prescription of opioids.

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