Choosing Wisely:

Don’t prescribe opiates in acute disabling low back pain before evaluation and a trial of other alternatives is considered.

Rationale and Comments: Early opiate prescriptions in acute disabling low back pain are associated with longer disability, increased surgical rates, and a greater risk of later opioid use. Opiates should be prescribed only after a physician evaluation by a licensed health care provider and after other alternatives are trialed.
Sponsoring Organizations:
  • American Academy of Physical Medicine and Rehabilitation
  • Sources:
  • Retrospective cohort study
  • Disciplines:
  • Orthopedic
  • References: • Webster BS. Verma SK. Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine. 2007 Sep 1;32(19):2127–32.

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