“Considering the evidence and specialty guidelines from the American College of Physicians, American Pain Society, and American College of Emergency Physicians that support conservative management rather than opioids as initial therapy for AOLBP, we still have a ways to go, but it’s a start,” Dr del Portal said.

Directions for Future Research

According to Dr del Portal, future efforts should explore ways for healthcare providers to support recovery from opioid addiction; limiting overprescribing is an important first step. Prescribing guidelines appear to be an effective part of the solution, and additional research is needed to explore the safety and efficacy of opioid alternatives.

TRENDING ON CPA: More than 75% of High School Heroin Users Started With Prescription Opioids 

Dr. Deitz, an internal medicine specialist with nearly 20 years of ED experience, is interested in determining whether institutional quality is an indicator of best prescribing practices.

“If a patient is seen in a facility that scores high according to indicators of high-quality health care, is that patient less likely to receive opioids or other inappropriate care than a patient seen at a facility that appears to be a lower performer?,” Dr Deitz asked.

Though opioids are generally not an appropriate first-line treatment for back pain, they may be indicated under certain circumstances. One benefit of a voluntary rather than mandatory guideline is that it allows room for clinical discretion.

“The guideline still offers prescribers the discretion to decide on the best therapy for an individual patient, but it promotes a conversation with patients about the risks of opioids, and facilitates the discussion when a prescriber decides an opioid is not in the patient’s best interest,” Dr del Portal concluded.


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