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

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.