Low Back Pain and the Connection to the Opioid Epidemic

By Dr. Anne Docimo, Chief Medical Officer, UnitedHealthcare

For the millions of Americans with low back pain, the condition can range from a minor nuisance to a major disability. For some, it may even lead to opioid use and abuse. In fact, opioids are prescribed for 9% of people with new-onset low back pain, ranking it the most common reason for an opioid prescription.1

Nearly 70% of people experience low back pain at least once in their lifetime, and about one-quarter of adults in the United States report experiencing the condition in the past 3 months.2 3 The causes vary, including previous injury, aging, muscular issues or arthritis of the spine.  

Recognizing the connection between back pain and opioids is important considering that almost 2 million people million people in the United States experience opioid use disorder, and more than 47,000 Americans each year die from overdoses related to prescription or illicit opioids.4

With that in mind, consider these tips to help reduce the risk of low back pain and complications: 

Stay Active

While some people with low back pain may be tempted to consider bed rest, studies show that remaining active is the best option in most cases. Activities to consider include walking and swimming, while yoga and tai chi have been shown to ease moderate to severe low back pain.5 6 Avoid long hours of sitting, as this can reduce mobility and hinder recovery.  

Consider Care Options

The American College of Physicians (ACP) recommends non-surgical options for initial treatment, including physical therapy, chiropractic care, acupuncture and over-the-counter anti-inflammatory medicines.7 Osteopathic manipulative treatment, a hands-on technique that includes stretching and gentle pressure, has been shown to reduce back pain.8 In fact, these noninvasive care options help 95% of people with back pain recover after 12 weeks.9 Muscle relaxants and imaging, such as an MRI, should be secondary options, and surgery should be a last resort. Opioids should be avoided. However, certain "red-flag" symptoms, such as fever or loss of bladder and bowel control, may require immediate testing and intervention.10

Recognize the Risks of Digital Devices

The average American spends nearly three hours per day on smartphones, which can contribute to poor neck posture.11 12 This forward-drop to look at the screen may change the natural curvature of your spine, placing strain on your neck muscles. Instead of tilting your chin down, raise the device to eye level. Also, avoid tucking your mobile device between your ear and shoulder, and instead use a speakerphone or headset.  

Stay Safe at Work

When standing or sitting at your computer or workstation, make sure your shoulders are in a straight line over your hips and your ears are directly over your shoulders. Generally, when working at a computer, people’s hands, wrists and forearms should be straight, in-line and parallel to the floor to help reduce the risk of musculoskeletal issues. 

Even for people with chronic low back pain that lasts more than two months, only a small percentage will need to have more invasive procedures or surgery. By taking preventive steps – and selecting evidence-based care approaches – you may help reduce the risks and complications associated with low back pain.

Footnotes

  1. OptumLabs. 2018 Opioid KPI Metrics.
  2. Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2015;388:1603–1658.
  3. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6):968-74.
  4. CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018
  5. National Institutes of Health, https://www.nih.gov/news-events/nih-research-matters/yoga-eases-moderate-severe-chronic-low-back-pain, 2017
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850460/, 2016
  7. American College of Physician Guidelines. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. http://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice. April 4, 2017.
  8. https://db.cngb.org/search/literature/27455103/, 2016
  9. Cleveland Clinic. Chronic Back Pain. https://my.clevelandclinic.org/health/diseases/16869-chronic-back-pain. Accessed July 2019.
  10. Harvard Medical School, https://www.health.harvard.edu/pain/when-is-back-surgery-the-right-choice, 2014
  11. eMarketer, https://www.emarketer.com/content/us-time-spent-with-mobile-2019, 2019
  12. Cleveland Clinic, https://health.clevelandclinic.org/text-neck-is-smartphone-use-causing-your-neck-pain/, 2015