Acute Low Back Pain

low back pain
Low Back Pain (LBP) is Very Common, Causing More Disability Around the World Than Any Other Condition[1]

In one study, it was the most common type of pain reported by patients, with 25% of U.S. adults reporting LBP in the prior 3 months.[2]

LBP is frequently classified based on several clinical characteristics, including duration of symptoms.

  • Acute back pain is often defined as lasting less than 4 weeks.
  • Subacute back pain lasts 4 to 12 weeks.
  • Chronic back pain lasts more than 12 weeks.

Many patients do not present for medical care for acute LBP,[3] as it typically will resolve on its own without intervention.

Opioids Continue to be Prescribed for LBP, Despite an Overall Lack of Evidence to Support its Efficacy

Despite an overall lack of evidence to support its efficacy, opioids continue to be prescribed to treat acute LBP when patients seek medical evaluation. In one study, 13.7% of 2017 visits for acute LBP covered by private insurance were associated with an opioid prescription. Prescriptions were for a median days’ supply of 7 (interquartile range 4-15 days) and median daily dosage of 21.4 MMEpdf icon.[4] Another recent study found that in 2015, 27% of opioid-naïve patients with newly diagnosed low back or extremity pain received an opioid prescription.[5]

Prescription Frequency

14 percent

Almost 14% of insured patients who sought care for low back pain, were prescribed opioids.

Too Many Pills, Too Many Times

3 days and dosage of 37 MME

Opioids are prescribed for acute low back pain at a median total of 21.4 MME and an average of 7 days supply.

Summary of Treatment Recommendations

American College of Occupational and Environmental Medicine

Practice Guidelines: Opioids for Treatment of Acute, Subacute, Chronic, and Postoperative Painexternal icon (2017)

“Routine opioid use for treatment of nonsevere acute pain (e.g., low back pain, sprains, or minor injury without signs of tissue damage [is not recommended].”

The American College of Physicians (ACP)

From the Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guidelineexternal icon (2017)

“Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugsexternal icon or skeletal muscle relaxants (moderate-quality evidence).”

Washington State Agency Medical Directors' Group

Interagency Guideline on Prescribing Opioids for Painpdf iconexternal icon (2015)

“…The use of opioids [in the acute phase] for non-specific low back pain, headaches, and fibromyalgia is not supported by evidence.”

[1] Hoy D, March L, Brooks P et al. The Global Burden of Low Back Pain: Estimates from the Global Burden of Disease 2010 Study. Ann Rheum Dis. 2014 Jun;73(6):968-74.
[2] Deyo RA, Mirza SK, Martin BI. Back Pain Prevalence and Visit Rates: Estimates from U.S. National Surveys, 2002. Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7.
[3] Carey TS, Evans AT, Hadler NM et al. Acute Severe Low Back Pain. A Population-Based Study of Prevalence and Care-Seeking. Spine (Phila Pa 1976). 1996 Feb 1;21(3):339-44.
[4] Mikosz CA, Zhang K, Haegerich T, Xu L, Losby JL, Greenspan A, Baldwin G, Dowell D. Indication-Specific Opioid Prescribing for US Patients with Medicaid or Private Insuranceexternal icon, 2017. JAMA Network Open. 2020;3(5):e204514. doi:10.1001/jamanetworkopen.2020.4514
[5] Azad TD, Zhang Y, Stienen MN et al. Patterns of Opioid and Benzodiazepine Use in Opioid-Naïve Patients with Newly Diagnosed Low Back and Lower Extremity Pain. J Gen Intern Med. 2019 Nov 12.