Why Spine Specialist Are Wary Of High-Dose Opioids As A First Line Of Treatment
Category: Back Pain | Author: Stefano Sinicropi | Date: November 11, 2026
Spine pain can be incredibly debilitating, and both patient and doctor have a strong desire to work to find a solution. High-dose opioids can be effective at masking strong pain sensations, but there are a number of reasons why many spine specialists are leery to offer them after an initial consultation or as a first line of defense. Below, we explore why high-dose opioids can cause problems as a first line of treatment for moderate to severe back pain.
Back Pain And Strong Painkillers
As doctors, we are always trying to balance treatment with the risks they pose. It’s a foundation of the hippocratic oath, which pledges that a doctor will do their best not to harm a patient. When it comes to high-dose opioid painkillers, the risk of harm is much higher than other treatment strategies.
That risk was confirmed in a recent study published in JAMA Network Open, which took a closer look at the risk posed by using high-dose opioids as a first line of treatment for patients with back pain. In that study, researchers found that patients who received a first-month treatment of opioids above 50 milligrams of morphine equivalent per day had a 146.6% higher relative risk of showing signs of an opioid use disorder or overdose compared to patients who were given a different form of treatment.
Researchers did note that the relative risk of developing an opioid use disorder was still relatively small, but the data is nonetheless concerning. About 2.3% of individuals given these strong painkillers as a first line of treatment experienced:
- A new opioid disorder diagnosis
- A nonfatal overdose
- A prescription for an addiction treatment drug like buprenorphine or methadone
Even lower dose prescriptions were associated with an increased risk of developing an opioid disorder. Those with a lower-dose opioid prescribed for more than seven days as the first line of treatment were linked to a 105.2% increased risk of developing an opioid-use disorder. Regimens of seven days or less carried a 31.2% increased risk.
However, a promising trend emerged when other treatments were pursued. Researchers found that patients who pursued chiropractic care for low back pain saw a 32.8% decreased risk in developing an opioid-use disorder, while those who began physical therapy as their first treatment option saw a 31.1% lowered risk.
That’s not to say that opioids should never be considered as part of a comprehensive treatment program, but countless studies have found that treatments like physical therapy, chiropractic care and cognitive behavioral therapy are both more effective at managing the underlying spinal issue while also keeping risk of dependency issues low. The data is showing that for many, the potential benefits simply do not outweigh the potential risk associated with opioids as a first line of treatment, especially high dose medications.
If you’re looking to connect with a physician who will take the time to really get to know you and the condition you’re dealing with so that a comprehensive, individualized treatment program can be developed and tailored to your unique needs, look no further than Dr. Sinicropi and the team at Midwest Spine & Brain Institute. For more information on how we can assist with all your back and neck issues, give our office a call today at (651) 430-3800.
