Chronic Low Back Pain: When High-Risk Treatments Cause More Harm Than Benefit

Pharmacy Times speaks with Caitlin Jones, PHD, a post doctoral research associate for the Institute for Musculoskeletal Health at the University of Sydney on opioids, spinal cord stimulators, and treatment-related harms in chronic low back pain.

Jones discusses why high-risk treatments for chronic low back pain deserve closer scrutiny, particularly when their potential harms outweigh their limited benefits. She identifies invasive procedures, implanted devices, and certain medications as areas requiring urgent re-evaluation, noting that high-quality randomized controlled trials have found little or no meaningful benefit for some commonly used interventions.

Jones highlights spinal cord stimulators as a key example. Although some lower-certainty and potentially conflicted studies have reported benefits, she explains that blinded, placebo-controlled trials have not demonstrated meaningful reductions in pain. She also emphasizes the substantial risks and costs associated with these devices, including infection, lead displacement, neurologic injury, repeat surgery, and other serious complications. According to Jones, approximately 30% of patients may require surgical reintervention after implantation, while the devices can cost tens of thousands of dollars. She cautions that describing spinal cord stimulation as “minimally invasive” or as a safe alternative to long-term opioid therapy may give patients an incomplete picture of the procedure.

The discussion also examines opioid therapy for chronic low back pain. Jones explains that opioids provide only small average improvements compared with placebo—approximately 1 point on a 10-point pain scale—and have not shown greater benefits than alternatives such as nonsteroidal anti-inflammatory drugs. At the same time, opioid-related risks can increase with prolonged use. These include physiological dependence, reduced analgesic effect over time, dose escalation, constipation, dizziness, addiction, overdose, and death.

Jones acknowledges that patients living with persistent pain may be willing to accept considerable risk in search of relief. However, she argues that treatment decisions must be based on transparent communication about the strength of the evidence, realistic expected benefits, financial burden, and the full range of potential harms. This allows patients to make genuinely informed, evidence-based treatment choices.