Commentary: Long-Term Opioid Therapy vs. Serial Intraspinal Injections for Low Back Pain

Abstract

Low back pain (LBP) is a highly prevalent condition with significant health-related morbidity and a 
detrimental impact on society.  There are several non-pharmacologic treatments for chronic LBP 
including physical therapy, aerobic exercise, and alternative treatments such as acupuncture. There are 
no studies that directly compare percutaneous spinal interventions to opioid therapy for LBP. It is 
unclear whether safe and high-quality healthcare will be achieved if the population of patients with 
chronic pain is steered towards chronic opioid therapy vs. procedural alternatives. More research is 
needed to elucidate the mechanism of action both of opioids and intraspinal steroid injections in chronic 
LBP. We argue that the safest and most patient-centered strategy to treat LBP is to maintain the current 
clinical guidelines until there are evidence-based guidelines to support an alternative treatment 
algorithm.