Neurological and Spine Institute

Why Opioids Are Not Regularly Prescribed for Back Pain


While back pain can be debilitating, it is rarely managed with opioid medications such as morphine, oxycodone, hydrocodone, fentanyl or codeine. Patients should not expect to get a prescription for opioid pain medications as a first line treatment for acute or chronic back pain at a physician visit or in the emergency department. This is for multiple reasons:

  1. Research has shown no opioid medication manages pain better than NSAIDs for musculoskeletal injuries, such as sprains, whiplash or muscle strain.
  2. The risk of addiction, known as Substance Use Disorder (SUD), is very high with any opioids.
  3. Other side effects of opioids are also problematic and include drowsiness, confusion, nausea and constipation.
  4. Non-pharmacological (non-medicine) treatments, such as physical and occupational therapy, not only help heal the injury but also strengthen the body to help prevent another injury.
  5. Pain management procedures, such as nerve blocks or steroid injections, can offer longer term pain control than opioid medication.

If patients do not respond to initial treatments, they may be referred to a physiatrist or pain management specialist who can explore alternative approaches.

For the few patients who are eventually prescribed opioid medications for chronic pain, the managing physician will require patients to sign and adhere to a pain management agreement in compliance with state and federal guidelines.

In some situations, such as following surgery or patients with cancer or sickle-cell disease, opioids may be prescribed upon discharge from the hospital. It is recommended that no more than a seven-day supply of medication be prescribed, and that all medication is securely stored in the home. To learn more about Riverside’s approach to safely managing pain after surgery, please see this video.

For individuals struggling with Substance Use Disorder, Riverside offers drug and alcohol addiction recovery programs for adults and teenagers. For more information, see the Riverside’s Addiction Recovery website, talk to your primary care provider for a referral or call 1-757-827-3119 for more information.



CDC Clinical Practice Guideline for Prescribing Opioids for Pain Management – United States, 2022 ttps://