Treatment of Midlife Women with Chronic Low Back Pain—Opioids Are a Last-Resort Option

Purpose of Review The purpose of this narrative review is to inform readers of the particular impact opioids have had on midlife women and to provide perspective on non-opioid treatment options for women with chronic low back pain. Recent Findings Research has shown that midlife women experience more chronic low back pain than men and other age groups of women. As a result, opioids have been particularly deleterious in this demographic group. In addition, there are no data to recommend them for long-term use, while there is a breadth of data on the negative consequences of long-term opioid use. Treatment guidelines now recommend non-pharmacologic agents as the first-line treatments, followed by non-opioid pharmacologic agents. Opioids are to be prescribed only if patients have failed non-pharmacologic and non-opioid pharmacologic agents and if the potential for benefit outweighs the potential for harms. Summary Midlife women experience more chronic low back pain than men and other age groups of women. Opioids have resulted in particularly poor outcomes in this population, with the greatest rise in opioid overdose deaths occurring in midlife women. Treatment guidelines now place emphasis on non-pharmacologic treatments and non-opioid pharmacologic treatments first, while opioids are a last resort. More and better quality research is needed on existing non-opioid treatment options in order to establish better guidelines and to determine long-term outcomes with these therapies.