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Chronic opioid analgesic therapy for chronic low back pain
R L Brown1, M F Fleming, J J Patterson
1Department of Family Medicine, University of Wisconsin Medical School, Madison 53715, USA.
Summary
Opioid therapy can be safe and effective for chronic low back pain when carefully managed. Physicians should consider chronic opioid analgesic therapy (COAT) for select patients with severe pain unresponsive to other treatments.
Area of Science:
- Pain Management
- Pharmacology
- Clinical Research
Background:
- Chronic low back pain affects 11% of American adults, often severely and disabling.
- Many current texts advise against opioid use for these patients without original research support.
Purpose of the Study:
- To formulate recommendations for implementing chronic opioid analgesic therapy (COAT) for chronic low back pain.
- To review original research on opioid use for chronic noncancer pain.
Main Methods:
- Conducted a MEDLINE literature search for original research on opioids for chronic noncancer pain.
- Included review articles and book chapters, combined with authors' clinical experience.
- Formulated recommendations for COAT implementation in chronic low back pain.
Main Results:
- No controlled studies were found; case series (566 patients) suggest COAT is safe and effective for recalcitrant pain.
- Identified contraindications: substance use disorders, personality disorders, certain medical/occupational factors.
- Monitoring includes contracts, interviews, drug testing; key parameters are pain and function. Exercise and nonpharmacologic treatments are recommended.
Conclusions:
- Physicians should consider COAT for selected patients with severe chronic low back pain.
- COAT may be a viable option for patients inadequately responding to other treatments.