Treating low back pain without opioids

Back pain is one of the most common disabling work injuries. In some cases surgery can provide permanent relief. But millions of people face the prospect living with chronic back pain for the rest of their lives. To get relief, some turn to opioids such as Oxycontin and Vicodin. But the relief those medications provide come at a terrible price – the risk of opioid addiction. What other treatment options are there for injured workers suffering from chronic back pain?

Alternatives to opioids

The general consensus among doctors and public health professionals is that opioids should be prescribed for the treatment of chronic pain only as a last resort. The American College of Physicians (ACP) agrees and has recently issued new treatment guidelines.

These treatment guidelines group the various alternatives into three categories, based on their effectiveness as demonstrated in clinical testing:

Recommendation 1

• Superficial heat
• Non-steroidal anti-inflammatory medications and skeletal muscle relaxants

ACP recommends the use of these treatments as a first resort because there is good clinical evidence that they can be effective. Other treatments cited in this category, though the quality of evidence of their effectiveness is lower, are:

• Massage
• Acupuncture
• Spinal manipulation

Recommendation 2

• Exercise
• Multidisciplinary rehabilitation
• Acupuncture
• Mindfulness-based stress reduction

Other treatments in this category with lower quality of evidence are:

• Tai chi
• Yoga
• Motor control exercise
• Progressive relaxation
• Electromyography biofeedback
• Low-level laser therapy
• Operant therapy
• Cognitive behavioral therapy
• Spinal manipulation

Recommendation 3

Patients who have not obtained relief through non-pharmacologic therapy should try:

• Nonsteroidal anti-inflammatory drugs as first-line therapy
• Tramadol or duloxetine as second-line therapy

Neuromodulation devices

There is another type of treatment for chronic pain that was not mentioned in ACP’s guidelines: neuromodulation devices, also known as spinal cord stimulators. First developed in late 1980s, these medical devices electrically stimulate the nerves in the back. This product category is dominated by Medtronic, St. Jude Medical, and Boston Scientific. Over the years, spinal cord stimulators have become smaller and more comfortable. One drawback is that they need to be surgically implanted, though a patient can test out a wearable device for a couple of weeks to see if it is effective. There are also smaller, wearable spinal cord stimulators coming on to the market.

If you suffer from work-related chronic pain, help may be available. Talk with an experienced workers’ compensation attorney.

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