Opioid for low back pain

There is no evidence to support the use of epidural injections of steroids, local anesthetics and/or opioids for low back pain without radiculopathy.

The risk of continued opioid use in the treatment of LBP increased not only with pain intensity but also with levels of depression during the course of treatment ¹⁾.

There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat chronic low back pain CLBP compared with placebo. The effectiveness and safety of long-term opioid therapy for treatment of CLBP remains unproven ²⁾.

There is some evidence (very low to moderate quality) for short-term efficacy (for both pain and function) of opioids to treat CLBP compared to placebo. The very few trials that compared opioids to non-steroidal anti-inflammatory drugs (NSAIDs) or antidepressants did not show any differences regarding pain and function. The initiation of a trial of opioids for long-term management should be done with extreme caution, especially after a comprehensive assessment of potential risks. There are no placebo-RCTs supporting the effectiveness and safety of long-term opioid therapy for treatment of CLBP ³⁾.