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Another Voice: Prescribing opiates for back pain risks addiction

By Gale Burstein and Richard Vienne

If there’s a feeder system for developing future opioid addiction, it includes narcotic treatment for back pain without medical justification.

More than 80 percent of adults will experience lower back pain at some point in their lives, according to a Univera Healthcare review of upstate New York population data. Among the report’s findings is that medical professionals often focus on treating the pain, rather than addressing quality of life or ability to function. The result is that prescription painkillers, including opiates, are widely prescribed, despite medical evidence that they rarely hasten recovery and carry with them the substantial risk for long-term abuse.

According to the Univera report on spine care in upstate New York in 2013, more than 625,000 adults received medical care for back and/or neck pain. Almost half of those patients treated received a prescription to treat the condition within the first six weeks of diagnosis. And more than half of those patients were prescribed an opiate.

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, collected care recommendations from physician-led medical specialty societies for the purpose of improving the quality of care and encouraging physician-patient conversations about services that may be unnecessary and may cause harm. The American Academy of Physical Medicine and Rehabilitation recommends: Health care providers should only prescribe opiates for acute disabling low back pain after an evaluation and when other alternatives have been tried. Prescribing opiates early for acute disabling low back pain is associated with longer disability, higher surgical rates and a greater risk of later opioid use.

Back pain often is a mechanical disorder, and should be treated with a mechanical approach – movement. Movement has been shown to speed recovery and lessen or relieve the pain. The best advice for most patients with back pain is to stay active, and use heat, ice or over-the-counter pain relievers, such as ibuprofen or acetaminophen.

The Erie County Department of Health reports that the number of opioid-related overdose deaths may double again this year. Erie County has a public health crisis with opioid misuse and deaths that often stems from taking a legitimate prescription for problems such a back pain. That is why it is imperative that clinicians incorporate the actual addictive risk of opioid prescribing into their prescribing decisions and patient counseling, and patients should ask about alternatives to prescription pain medication when offered for an acute pain episode.

Univera’s report on spine care is at tinyurl.com/jxxor87.

Gale Burstein, M.D., M.P.H., is Erie County health commissioner. Richard Vienne, D.O., is vice president and chief medical officer at Univera Healthcare.