Back pain is an important problem for primary care physicians; it is common, costly, and
controversial. Back pain is the second leading symptom prompting all physician visits in the
United States. There are wide geographic variations in medical care for this problem, and
surgical rates in the United States are twice those of most developed countries. The
treatment of back pain has followed a series of fads and fashions, and work disability
resulting from back pain continues to rise. For all these reasons, primary care clinicians have …

Back pain affects most adults, causes disability for some, and is a common reason for
seeking healthcare. In the United States, opioid prescription for low back pain has
increased, and opioids are now the most commonly prescribed drug class. More than half of
regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are
two to three times higher than in most European countries. The analgesic efficacy of opioids
for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not …