Do strong opioids have a role in the early management of back pain? Recommendations from a European expert panel

Eija Kalso, Laurie Allan, Jan Dobrogowski, Martin Johnson, Nevenka Krcevski-Skvarc, Gary J. Macfarlane, Gérard Mick, Sergio Ortolani, Serge Perrot, Alfredo Perucho, Ian Semmons, Jan Sörensen

Research output: Contribution to journalArticlepeer-review


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. Recommendations: 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.

Original languageEnglish
Article number3159
Pages (from-to)1819-1828
Number of pages10
JournalCurrent Medical Research and Opinion
Issue number11
Publication statusPublished - Nov 2005


  • Analgesia
  • Back pain
  • Chronic pain
  • Opioids

ASJC Scopus subject areas

  • Medicine(all)


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