Chronic Low Back Pain: Recognizing Treatment Harm and Improving Access to Better Care

Pharmacy Times speaks with Caitlin Jones, PHD,a post doctoral research associate for the Institute for Musculoskeletal Health at the University of Sydney on how evidence gaps, opioid dependence, and misaligned incentives can undermine pain care.

Jones discusses how well-intentioned treatment decisions can still harm patients with chronic low back pain. She explains that most clinicians enter health care with good intentions, but many receive limited training in critically appraising research. As a result, they often rely on clinical guidelines, which may be outdated, low quality, unavailable, or influenced by conflicts of interest. Jones argues that both clinicians and patients need faster access to clear, trustworthy, and current summaries of evidence to support better treatment decisions.

Jones also describes the importance of regularly asking patients how their pain, side effects, costs, and overall quality of life are changing. Whether a treatment remains worthwhile is ultimately an individual judgment, because some patients may accept certain adverse effects in exchange for meaningful relief. However, opioid therapy requires particular caution. Physiological dependence can develop after prolonged use—and sometimes within only a few weeks—and should not be confused with addiction. Withdrawal symptoms after a missed or reduced dose may be misinterpreted as proof that the opioid was controlling the patient’s pain. Jones emphasizes that opioid tapering should be gradual, consensual, medically supervised, and supported, noting that forced or abrupt discontinuation can also cause harm.

Finally, Jones discusses how marketing and health-system incentives can steer patients toward lower-value care. She calls for reducing promotional “noise” around medical interventions and improving access to unbiased evidence. She also highlights how funding structures may make medicines, injections, and surgery less expensive than physiotherapy, psychological care, or multidisciplinary treatment, even when the latter may provide greater value with fewer risks. Jones argues that health systems should make low-risk, evidence-based options more affordable and accessible so that patients are naturally guided toward treatments most likely to improve long-term outcomes and reduce preventable harm across the system.