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Long-term Management of Low Back Pain with Opioids and Non-steroidal Anti-inflammatory Drugs in a Health System

      In the past 15 years, there have been marked increases in the use of opioids to treat chronic non-cancer pain.
      • Ahmedani B.K.
      • Peterson E.L.
      • Wells K.E.
      • Lanfear D.E.
      • Williams L.K.
      Policies and events affecting prescription opioid use for non-cancer pain among an insured patient population.
      • Bohnert A.S.
      • Valenstein M.
      • Bair M.J.
      • et al.
      Association between opioid prescribing patterns and opioid overdose-related deaths.
      • Boudreau D.
      • Von K.M.
      • Rutter C.M.
      • et al.
      Trends in long-term opioid therapy for chronic non-cancer pain.
      Yet, there remains little to no clinical evidence supporting the long-term effectiveness of this class of drugs or therapeutics for this indication.
      • Chou R.
      • Fanciullo G.J.
      • Fine P.G.
      • et al.
      Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
      Contemporaneous with the increase in opioid prescriptions, there has been a commensurate rise in opioid misuse.
      • Bohnert A.S.
      • Valenstein M.
      • Bair M.J.
      • et al.
      Association between opioid prescribing patterns and opioid overdose-related deaths.
      CDC
      Vital signs: overdoses of prescription opioid pain relievers—United States, 1999—2008.
      There are also serious risks associated with long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), a comparable analgesic, such as gastrointestinal bleeding and renal disease.
      • Kuritzky L.
      • Samraj G.P.
      Nonsteroidal anti-inflammatory drugs in the treatment of low back pain.
      Within the context of these known risks and recommendations to use both classes primarily for acute pain (except cautionary use for select conditions when there is clear longitudinal symptom improvement), it is unclear how often opioids and NSAIDs are prescribed long term, despite potential risks.
      • Kuritzky L.
      • Samraj G.P.
      Nonsteroidal anti-inflammatory drugs in the treatment of low back pain.
      • Hegmann K.T.
      • Weiss M.S.
      • Bowden K.
      • et al.
      ACOEM practice guidelines: opioids for treatment of acute, subacute, chronic, and postoperative pain.
      • Makris U.E.
      • Abrams R.C.
      • Gurland B.
      • Reid M.C.
      Management of persistent pain in the older patient: a clinical review.
      • Mai J.
      • Franklin G.
      • Tauben D.
      Guideline for prescribing opioids to treat pain in injured workers.
      This study compares long-term use of both classes for patients with non-cancer low back pain in a large healthcare system.
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