Opioids for back and neck pain: the OPAL trial

In this clinical scenario, the efficacy and benefits of opioids are the highest, and the standard of care by an emergency department physician is to administer a fast-release opioid.2 Few participants in their study fit into the category of early-onset pain. Most participants in both groups of their trial had a mean pain intensity of 5·8 (SD 1·6) on the Pain Severity Index. [...]their erroneous generalisation that “Opioids should not be recommended for acute non-specific low back pain or neck pain” ignores the clinical nuances of opioid prescription and guidelines. Despite the documented risks, which cannot be understated, opioids are indispensable for pain management, particularly in cases in which other forms of treatment are ineffective or inadequate.