Opioid Use for Chronic Low Back Pain

Franklin, Geralyn McClure; Rahman, Enass A.; Turner, Judith A.; Daniell, William; Fulton‐Kehoe, Deborah

doi:10.1097/ajp.0b013e3181b01710

Cited by 140 publications

(40 citation statements)

References 31 publications

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“…LtOT continuation is predicted by high daily opioid dose (>120mg morphine equivalent) and opioid misuse. Other prospective studies have shown similar findings [28; 67]. These data suggest that the population of patients on LtOT is progressively enriched with high-risk patients.…”

Section: Careful Selection Vs Adverse Selection Of Patients For Longsupporting

confidence: 80%

Opioid therapy for chronic pain in the United States: Promises and perils

Sullivan¹,

Howe²

2013

Pain

200

158

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Opioid therapy offers the promise of reducing the burden of chronic pain in not just individual patients, but among the broad population of patients with chronic pain. Randomized trials have demonstrated that opioid therapy for up to 12–16 weeks is superior to placebo, but have not addressed longer term use. In the US, opioid sales have quadrupled during 2000–2010 with parallel increases in opioid accidental overdose deaths substance abuse admissions. Clinical use of long-term opioid therapy is characterized by a pattern of adverse selection, where high-risk patients are prescribed high-risk opioid regimens. This adverse selection may link these trends in use, abuse and overdose. Long-term opioid therapy appears to be associated with iatrogenic harm to the patients who receive the prescriptions and to the general population. The US has conducted an experiment of population-wide treatment of chronic pain with long-term opioid therapy. The benefits have been hard to demonstrate, but the harms are now well demonstrated.

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Section: Careful Selection Vs Adverse Selection Of Patients For Longsupporting

confidence: 80%

Opioid therapy for chronic pain in the United States: Promises and perils

Sullivan¹,

Howe²

2013

Pain

200

158

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“…1,2 Many concerns have been raised regarding opioid prescribing, including addictive potential, misuse, and accidental overdose. 3,4,5,6 Several studies have shown that a history of illicit drug use is associated with prescription opiate misuse.…”

Section: Introductionmentioning

confidence: 99%

Illicit Substance Use in US Adults With Chronic Low Back Pain

Shmagel

Krebs

Ensrud

et al. 2016

Spine

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Study Design population-based cross sectional survey. Objective To compare the prevalence of illicit drug use among US adults with chronic low back pain (cLBP) and without. Summary of Background Data While addictive medications, such as opioids and benzodiazepines, are frequently prescribed to patients with cLBP, little is known about illicit drug use among Americans with cLBP. Methods We used data from the back pain survey, administered to a representative sample of US adults aged 20-69 (N = 5103) during the 2009-2010 cycle of the National Health and Nutrition Examination Survey (NHANES). Participants with pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold for at least 3 months were classified as having cLBP (N = 700). The drug use questionnaire was self-administered in a private setting, and included data on lifetime and current use of marijuana or hashish, cocaine, heroin, and methamphetamine. Chi-square tests, one way ANOVA and logistic regression, adjusted for age, gender, race and level of education, were used for comparisons. Results 46.5% of US adults with cLBP used marijuana vs 42% of those without cLBP (aOR 1.36, 95% CI 1.06-1.74). 22% vs 14% used cocaine (aOR 1.80, 95% CI 1.45-2.24), 9% vs 5% used methamphetamine (aOR 2.03, 95% CI 1.30-3.16), and 5% vs 2% used heroin (aOR 2.43, 95% CI 1.44-4.11). Subjects with cLBP who reported lifetime illicit drug use were more likely to have an active prescription for opioid analgesics than those without illicit drug use history: 22.5% vs 15.3%, p = 0.018. Conclusions cLBP in community-based US adults was associated with higher odds of using marijuana, cocaine, heroin, and methamphetamine. Prescription opioid analgesic use was more common in cLBP sufferers with a history of illicit drug use.

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“…Delayed return to work has been found among worker’s compensation patients using opioids relative to patients not using opioids, and those receiving higher opioid doses have longer delays in return to work than patients on lower doses. [13, 14, 20, 32, 35] There is evidence that patients with chronic pain receiving rehabilitative services who are withdrawn from opioids have improved outcomes. [4, 7, 10, 16, 18, 26, 29, 30] Given deficient scientific evidence, and large differences in analgesic response between patients, it is difficult to make categorical statements about the long-term effectiveness of COT for patients with chronic musculoskeletal pain, particularly when improved function is a primary goal.…”

Section: Opioid Effectivenessmentioning

confidence: 99%

Opioids for chronic musculoskeletal pain: Putting patient safety first

Korff

2013

Pain

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Opioid Use for Chronic Low Back Pain

Cited by 140 publications

References 31 publications

Opioid therapy for chronic pain in the United States: Promises and perils

Opioid therapy for chronic pain in the United States: Promises and perils

Illicit Substance Use in US Adults With Chronic Low Back Pain

Opioids for chronic musculoskeletal pain: Putting patient safety first

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