American Academy of Physical Medicine and Rehabilitation

View all recommendations from this society

September 29, 2015

Don’t prescribe opiates in acute disabling low back pain before evaluation and a trial of other alternatives is considered.

Early opiate prescriptions in acute disabling low back pain are associated with longer disability, increased surgical rates, and a greater risk of later opioid use. Opiates should be prescribed only after a physician evaluation by a licensed health care provider and after other alternatives are trialed.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) established a Choosing Wisely® task force to develop its list of recommendations. To ensure broad representation across our diverse specialty, members of this group were selected from varying practice settings and subspecialties within physical medicine & rehabilitation. The task force developed a list of topics they felt had the most impact on the field, which were then rated based upon their relevancy to the Choosing Wisely® campaign. Based on the task force ratings and a literature review, candidate recommendations were sent to relevant AAPM&R committees, councils and subject matter experts for review and comment. The task force reviewed this feedback and voted on the final “Top Five” recommendations, which were approved by the Evidence Based Practice Committee; Quality, Practice, Policy and Research Committee; and the Board of Governors.

AAPM&R’s disclosure and conflict of interest statements can be found at www.aapmr.org.

Sources

Webster BS. Verma SK. Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine. 2007 Sep 1;32(19):2127–32.