====== Opioid for low back pain ======

There is no [[evidence]] to support the use of [[epidural injection]]s of [[steroid]]s, [[local anesthetic]]s and/or [[opioid]]s 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
((Dengler J, Sturesson B, Kools D, Prestamburgo D, Cher D, van Eeckhoven E, Erk 
E, Gasbarrini A, Pflugmacher R, Vajkoczy P. Risk Factors for Continued Opioid Use
in Conservative Versus Surgical Management of Low Back Pain Originating From the 
Sacroiliac Joint. Global Spine J. 2018 Aug;8(5):453-459. doi:
10.1177/2192568217733707. Epub 2017 Oct 5. PubMed PMID: 30258750; PubMed Central 
PMCID: PMC6149042.
)).

====Reviews====
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
((Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC.
Opioids compared with placebo or other treatments for chronic low back pain: an
update of the Cochrane Review. Spine (Phila Pa 1976). 2014 Apr 1;39(7):556-63.
doi: 10.1097/BRS.0000000000000249. PubMed PMID: 24480962.
)).

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
((Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC.
Opioids compared to placebo or other treatments for chronic low-back pain.
Cochrane Database Syst Rev. 2013 Aug 27;8:CD004959. doi:
10.1002/14651858.CD004959.pub4. Review. PubMed PMID: 23983011.
)).