Frankly, the only reliable option for improving low back pain appears simply to be time, an unsatisfying situation for both patient and practitioner. Opiate analgesia lacks evidence of both efficacy and inefficacy. However, what has been clearly and repeatedly proven are adverse effects and downstream harms from opiate prescribing. Better evidence directly informing the immediate post-encounter period is sorely needed to either confirm or refute what likely remains widespread and common use in the acute setting.

Dr. Radecki is an emergency physician and informatician with Christchurch Hospital in Christchurch, New Zealand. He is the Annals of Emergency Medicine podcast co-host and Journal Club editor and can be found on Twitter @emlitofnote.

References

1. Centers for Disease Control and Prevention. US opioid dispensing rate map. CDC website. https://www.cdc.gov/drugoverdose/rxrate-maps/index.html. Last updated November 10, 2021. Accessed September 17, 2023.
2. Jones CMP, Day RO, Koes BW, et al. Opioid analgesia for acute low back pain and neck pain (The OPAL trial): a randomised placebo-controlled trial. The Lancet. 2023;402(10398):304-312.
3. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015;314(15):1572.
4. Friedman BW, Irizarry E, Solorzano C, et al. A randomized, placebo-controlled trial of ibuprofen plus metaxalone, tizanidine, or baclofen for acute low back pain. Ann Emerg Med. 2019;74(4):512-520.
5. Friedman BW, Irizarry E, Chertoff A, et al. Ibuprofen plus acetaminophen versus ibuprofen alone for acute low back pain: an emergency department-based randomized study. Acad Emerg Med. 2020;27(3):229-235.
6. Friedman BW, Irizarry E, Solorzano C, et al. Diazepam is no better than placebo when added to naproxen for acute low back pain. Ann Emerg Med. 2017;70(2):169-176.e1