Chronic Back Pain


    Chronic Back Pain

    You’re working overnight when your 10th patient comes in complaining of chronic back pain. You order acetaminophen and an NSAID but the patient refuses to take them. They’re upset, agitated and demanding their usual percocet as its the only thing that helps. You attempt to explain that opioids are not the best medication for this type of pain but the patient does not even let you finish your sentence. you decide to use this time to educate your patient.
    A recent RCT done randomized 240 patients with chronic back, hip or knee pain to opioid versus non-opioid medications. The opioid group was given immediate release opioids before escalation to sustained action or transdermal therapy. The non-opioid group received acetaminophen and NSAIDs before escalation to therapies including gabapentin, lidocaine and capsaicin. the primary outcome was pain-related function at 1 year using a a scale 0-10 with 10 being worse. At the end of the study there was found to be no difference between the two groups. Pain intensity actually favored the non-opioid group (although this may not be clinically significant). You also take this time to discuss the many undesirable medication related symptoms including the potential for abuse when using opioids from chronic pain.
    Your patient seems receptive and appreciates the time you took to explain this.
    The next time you’re on shift and have concerns that your patient may be misusing opioids you can print this card out for them at:
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