title: Do strong opioids have a role in the early management of back pain? Recommendations from a European expert panel.
abstract: BACKGROUND
  Since chronic low back pain (CLBP) is a complex biopsychosocial problem the ideal treatment is multimodal and multidisciplinary. However, in many countries, primary-care physicians care for many people with CLBP and have a pivotal role in selecting patients for more intensive treatments when these are available. Guidelines on the general use of strong opioids in chronic non-cancer pain have been published but, until now, no specific guidelines were available on their use in chronic low back pain. Given the prevalence of CLBP, and the complex nature of this multifactorial condition, it was felt that specific, evidence-based recommendations, with a focus on primary-care treatment, would be helpful.
  
  
  METHODS
  An expert panel drawn from across Europe including pain specialists, anaesthetists, neurologists, rheumatologists, a general practitioner, an epidemiologist and the chairman of a pain charity was therefore convened. The aim of the group was to develop evidence-based recommendations that could be used as a framework for more specific guidelines to reflect local differences in the availability of specialist pain services and in the legal status and availability of strong opioids. Statements were based on published evidence (identified by a literature search) wherever possible, and supported by clinical experience when suitable evidence was lacking.
  
  
  CONCLUSIONS
  Strong opioids have a role in the treatment of low back pain when other treatments have failed. They should be prescribed as part of a multimodal, and ideally interdisciplinary, treatment plan. The aim of treatment should be to relieve pain and facilitate rehabilitation.
authors.affiliation: Pain Clinic, Helsinki University Central Hospital, Helsinki, Finland. eija.kalso@hus.fi
authors.forename: Eija
authors.initials: E
authors.lastname: Kalso
authors.forename: Laurie
authors.initials: L
authors.lastname: Allan
authors.forename: Jan
authors.initials: J
authors.lastname: Dobrogowski
authors.forename: Martin
authors.initials: M
authors.lastname: Johnson
authors.forename: Nevenka
authors.initials: N
authors.lastname: Krcevski-Skvarc
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.forename: Gérard
authors.initials: G
authors.lastname: Mick
authors.forename: Sergio
authors.initials: S
authors.lastname: Ortolani
authors.forename: Serge
authors.initials: S
authors.lastname: Perrot
authors.forename: Alfredo
authors.initials: A
authors.lastname: Perucho
authors.forename: Ian
authors.initials: I
authors.lastname: Semmons
authors.forename: Jan
authors.initials: J
authors.lastname: Sörensen
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease / Q000188:drug therapy*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005060:Europe; D019317:Evidence-Based Medicine; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid