Benzodiazepines, opioids and spinal fusion surgery are all under the spotlight in a new suite of Choosing Wisely recommendations issued by pain experts.
Clinicians are being urged not to prescribe benzodiazepines for low back pain, nor refer those with axial lower lumbar back pain for spinal fusion surgery.
Speaking on behalf of the faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists, Dr Michael Vagg explained that the minor tranquilisers had little benefit in these patients.
“Low back pain is one of the most prominent pain conditions experienced by Australians. Up to 80% of people will experience low back pain at some point in their lives, with one in 10 being limited in their day-to-day activities and looking for relief.
“However, a recent review found there was no evidence to support people taking benzodiazepines as ‘muscle relaxants’ to relieve their low back pain, in addition to, or instead of, anti-inflammatory medicines.”
Instead, patients taking these medications risked abuse, addiction, tolerance and overdose resulting in accidental death, he said.
The faculty of pain medicine also reiterated advice from other colleges not to use opioids as a first-line or monotherapy for patients with chronic non-cancer pain.
Dr Vagg recognised that managing chronic pain was complex, but said there was “little evidence to support the use of opioids as the first or only treatment option”.
Instead, the faculty stressed the need for ongoing demonstration of benefit, periodic attempts at reducing the dose and screening for long-term harms.
They also recommended against pregabalin and gabapentin for pain that was not neuropathic.