Pubdate: Mon, 11 Apr 2016
Source: Buffalo News (NY)
Copyright: 2016 The Buffalo News
Contact: http://drugsense.org/url/GXIzebQL
Website: http://www.buffalonews.com/
Details: http://www.mapinc.org/media/61
Authors: Gale Burstein and Richard Vienne
Note: Gale Burstein and Richard Vienne Gale Burstein, M.D., M.P.H., 
is Erie County health commissioner. Richard Vienne, D.O., is vice 
president and chief medical officer at Univera Healthcare.

PRESCRIBING OPIATES FOR BACK PAIN RISKS ADDICTION

If there's a feeder system for developing future opioid addiction, it 
includes narcotic treatment for back pain without medical justification.

More than 80 percent of adults will experience lower back pain at 
some point in their lives, according to a Univera Healthcare review 
of upstate New York population data. Among the report's findings is 
that medical professionals often focus on treating the pain, rather 
than addressing quality of life or ability to function. The result is 
that prescription painkillers, including opiates, are widely 
prescribed, despite medical evidence that they rarely hasten recovery 
and carry with them the substantial risk for long-term abuse.

According to the Univera report on spine care in upstate New York in 
2013, more than 625,000 adults received medical care for back and/or 
neck pain. Almost half of those patients treated received a 
prescription to treat the condition within the first six weeks of 
diagnosis. And more than half of those patients were prescribed an opiate.

Choosing Wisely, an initiative of the American Board of Internal 
Medicine Foundation, collected care recommendations from 
physician-led medical specialty societies for the purpose of 
improving the quality of care and encouraging physician-patient 
conversations about services that may be unnecessary and may cause 
harm. The American Academy of Physical Medicine and Rehabilitation 
recommends: Health care providers should only prescribe opiates for 
acute disabling low back pain after an evaluation and when other 
alternatives have been tried. Prescribing opiates early for acute 
disabling low back pain is associated with longer disability, higher 
surgical rates and a greater risk of later opioid use.

Back pain often is a mechanical disorder, and should be treated with 
a mechanical approach - movement. Movement has been shown to speed 
recovery and lessen or relieve the pain. The best advice for most 
patients with back pain is to stay active, and use heat, ice or 
over-the-counter pain relievers, such as ibuprofen or acetaminophen.

The Erie County Department of Health reports that the number of 
opioid-related overdose deaths may double again this year. Erie 
County has a public health crisis with opioid misuse and deaths that 
often stems from taking a legitimate prescription for problems such a 
back pain. That is why it is imperative that clinicians incorporate 
the actual addictive risk of opioid prescribing into their 
prescribing decisions and patient counseling, and patients should ask 
about alternatives to prescription pain medication when offered for 
an acute pain episode.

Univera's report on spine care is at tinyurl.com/jxxor87.
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