RT Journal Article
SR Electronic
T1 Chronic Opioid Analgesic Therapy for Chronic Low Back Pain
JF The Journal of the American Board of Family
                Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 191
OP 204
DO 10.3122/jabfm.9.3.191
VO 9
IS 3
A1 Richard L. Brown
A1 Michael F. Fleming
A1 Jeffrey J. Patterson
YR 1996
UL http://www.jabfm.org/content/9/3/191.abstract
AB Background: Eleven percent of American adults have chronic low back pain—and many of these individuals have severe, disabling, refractory pain. Many texts recommend against using opioids for these patients without citing original research. Methods: A MEDLINE literature search was conducted for original research on the use of opioids for chronic noncancer pain. Additional references were also sought from review articles and book chapters. Based on this research and the authors’ clinical experience, recommendations were formulated for implementing chronic opioid analgesic therapy (COAT) for patients with chronic low back pain. Results: No controlled studies were found. Case series reports on a total of 566 patients suggest that COAT is safe and effective for many patients with recalcitrant chronic low back pain. Preexisting substance use disorders, personality disorders, certain medical conditions, and certain occupational factors are relative contraindications to COAT. Methods to prevent and monitor for drug problems among COAT recipients include contracts, family interviews, and drug testing. Pain and overall function are the key monitoring parameters. Once patients attain some relief, an exercise regimen should be initiated. Other nonpharmacologic treatments and nonopioids are also recommended. Conclusion: Physicians are encouraged to consider COAT for selected patients with severe chronic low back pain who respond inadequately to other treatments.