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At some point in their lives, 80 percent of adults will experience lower back pain. It’s the second most common reason that adults see a doctor and the most common reason for disability. It’s also a microcosm of all the things that are wrong with the U.S. health care system, including its contribution to the opioid crisis.

Having experienced lower back pain myself, I know that it can be truly debilitating. I would have done almost anything to rid myself of it. Lower back pain puts people in desperate and vulnerable positions, and it puts doctors under pressure to Do Something Now. From such a confluence arise many poor and potentially devastating treatments and choices.

Among the worst is doctors’ decisions to write opioid prescriptions as a treatment for lower back pain and their patients taking these drugs. Lower back pain is one of the most common reasons for an opioid prescription, but here’s the kicker: There’s no evidence that opioids are effective at treating this problem.


At best, opioids mask pain in the short term. It’s like turning up your car’s radio to drown out the horrible noises coming from under the hood while you drive: The radio might distract you, but the car’s underlying problem isn’t getting addressed and could cause serious harm. And taking opioids for lower back pain often means its cause is being ignored.

A trio of papers published last year in The Lancet examined global issues in the prevention and treatment of back pain. One of them confirms the prevalence of opioids in treatment, saying, “Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery.”


What works best for lower back pain is a combination of education and proper exercise, not the overprescription of opioid painkillers. Yet to this day, health plans pay for such non-evidence-based interventions like opioids and make it difficult and expensive for patients to access evidence-based interventions such as physical therapy. That doesn’t make sense until you look at the reason: For the carriers that administer health insurance plans, there is far more profit in pills than physical therapy. (This also explains why the three largest pharmacy benefits managers have recently merged with insurance carriers.)

Our entire health care system is built on a vast web of incentives that push patients down the wrong paths. And in most cases it’s the entities that manage the money — insurance carriers — that benefit from doing so. They negotiate prices with health systems and pharmaceutical companies, all of which share the objective of increasing revenues, to craft and sell health plans that offer trumped up “discounts.” As long as carriers negotiate a high price with a provider or a rebate scheme with a drug maker, they can still make a sizable profit even after a 50 percent discount.

This dynamic was accelerated by the Affordable Care Act’s Medical Loss Ratio, which requires that 80 percent of insurance premium dollars pay for medical expenses and that carriers pocket only 20 percent. It doesn’t take much to see that the higher the premium, the more they make from that 20 percent.

By being more concerned about profits than patients, most insurance carriers’ plans are flooding our society with addictive drugs. And employers are blindly buying in.

There is an alternative, and some innovative employers have already taken action.

Rosen Hotels, for example, created a health plan for its employees that prioritizes proper primary care to better meet their needs — lower back pain among them. A key component of the company’s health plan is that instead of sending employees to volume-centric providers like status quo carrier plans do, it sends beneficiaries to value-based primary care physicians who are rewarded for positive patient outcomes and who prescribe treatments to address pain over pills.

Among the many benefits Rosen Hotels saw from this, one of the most impressive is that despite having employees with physically demanding jobs, the company was able to reduce opioid prescriptions so that they are one-sixth of those seen among employees of most other U.S. companies.

An estimated 700,000 people are likely to die from opioid overdoses between 2015 and 2025, making it absolutely essential to understand the connections between insurance carriers, health plans, employers, the public, and the opioid crisis. We will never get out of this mess unless we stop addiction before it starts, as Rosen Hotels is doing.

The core thesis of my latest book, “The Opioid Crisis Wake-up Call,” is that the opioid crisis isn’t an anomaly. It’s a side effect of our health care system. And while the enormity of the opioid crisis can certainly be discouraging, there is a silver lining: Since it is a microcosm of even larger health care dysfunction, those who are able to use their health insurance plans to tackle the opioid crisis can simultaneously solve health care’s systemic problems.

Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, nonpartisan fixes to the U.S. health care system, and author of “The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back” (Health Rosetta Media, September 2018).

  • I have had 3 spinal fusions and an ankle fusion along with both feet that have been broken, degenerative disc disease, rheumatoid arthritis and osteoporosis. I have and know what pain is! Of course no more opioids which did not take away all the pain but enabled me to be able to care for my husband and 2 sons. People that have had a little back pain and needed off work a day or two really have no idea what it’s like to live with debilitating pain. In the last 2years I’ve had over a yr of physical therapy without relief from the pain. I can honestly say, I understand why some people commit suicide to end the pain. I was switched to Tylenol 3 without much relief and I do think it’s cruel and inhumane to have the ability to help someone but refuse too. I also have 3 insurance policy’s but still can’t afford to see a Dr. is also sad. Without Indian Health Services I don’t know what I’d do. My heart hurts for those in pain and can’t be treated for it.

    • Dear Pam, My heart is breaking for you! I too have experienced unrelenting pain and have been blessed to have found some better ways to manage my pain. If you’d like, i offer a free coaching session to explore some ways to step into the light with your lovely body. [email protected]

    • Alot of people in our government are responsible for the unnecessary and preventable suffering and death of pain patients like you all. For Gods sake, is anyone or any group…somebody going to hold them accountable for all this atrocity?? Probably not in this life…

    • The Trolls are lining up here, seeking out desperate commenters. There are too many people posting about their long term intractable pain, surgical mishaps, multiple surgeries, and amputations, on here. This is their last vestige of hope. The FDA failed to do any research or take their comments. Many were shamed into silence, because psychologists got articles run in mass media, claiming that these people did not exist or where mentally ill. Even now on Facebook, when desperate people post, these comments are sold to third party propagandists and marketers.

      Please note that the above book advertisement did not mention any of these topics.

      At least one brave Marine tried to do something. The VA has been silent about the number of Vets they denied treatment for chronic pain. The VA even created a counter narrative, they paid the same psychologist who created the Torture Program, to mislead the public about pain and battlefield trauma. Of course all of that research was based on Dogs!

    • I have had similar orthopedic surgeries over the past 5 years from age 60-65. All of it’s pain, it’s limitations, and alterations in managing any quality of life long term from pre-op to post-op using opiates requires extensive and intensive pain management modalities, patient education and support, that includes use of alternative therapies pre-op and post to prevent opiate addiction. Indeed it’s true, in my opinion, that the opiate epidemic, at its root-cause, is an outcome of a combined pharmaceutical insurance driven for profit industry that promoted its pharmaceuticals but didn’t include cost-effective planning or promoting for the use of industry wide required patient education services, multi-disciplinary pain management treatment teams and rigorous physical therapies.

  • Thank you Mavis. Spot on. I want to ask you what you think about something. Why are people not losing their jobs in these different parts of government over this? Surely, their superiors have to be taking alot of heat over it? Overdoses and deaths are rising from illicit use. Prescription amounts are falling at same time. Tragically, suicide deaths amoung chronic pain patients is up. Seems like a total failure on their part. Please answer if you would. If not, thats ok. I’m glad to have read your just posted response.

  • This one here is partially true, this so called epidemic has a lot to do with the insurers and the medical, and pharma industries profiteering. Even though rates of reported “back pain” have been increasing, not much meaningful research was done. Millions of blue collar and other workers were forced to return to work, unable to afford a few days off to deal with back pain. Their only choice was to take opioids to deal with the pain to continue functioning.

    Every article on this topic is deliberately deceptive by design. The opioid epidemic false narrative is perpetuating the problem, and the false narrative has been running for more than 2 decades. We have had a lot of wake up calls over the years, yet not one sensible of scientific answer to the problem.

    Each of these thought provoking articles or pieces of advertising, and content marketing restates a lie, or an untruth. They typically focus on “back pain” in the research and these unscientific articles, because it is hard to quantify. Back pain can mean anything from temporary discomfort from sitting too long, to intense agony form damaged nerves and tissue. The researchers in their pursuit of positive outcomes selected for certain kinds of back pain, the kind that is relieved with a little rest or exercise. This way they could claim anything from attitude to electrical devices are cures for back pain. They created a profitable industry misleading Americans about pain and opioids.

    The blanket statement that “opiates are not effective for back pain” is a lie. Of course 90% of the time, a change of routine, exercise or a day off will relieve back pain, with no need for opiates or other medications. It is the other cases, where there is damage to the spine, which tends to conveniently get avoided by these content marketers. There is a big difference between run of the mill back pain, and people who have significant injuries, implants, amputations, genetic disorders, and post surgical complications. According to years of practice, research and reports by these patients, opiates are the only effective treatment for their pain.

    What we have here is lying and misreporting, instead of a fact based “opinion.” Opiates may not cure any disease, but they do allow people to maintain some basic quality of life, when they have intractable chronic pain.

    This is not about the 90 % of people with back pain, it is about the 5% that have extensive damage. These misreported and deceptive opinions have led to the cruel torture of people with chronic pain. They have also obscured the role of the assembly line medical system, insurers and failures of healthcare. At the same time they repeat misinformation and lies about addiction.

    Thsi country still does not have an answer to the so called opiate epidemic, which is really an Epidemic of Despair. Instead of a factual science based approach the lies, marketing and hysteria are now driving an illegal Fentanyl Epidemic.

    Here in America policy is based on beliefs. The Market Based Healthcare system, created Perdues marketing campaign. Some of us, with a background in History, knew about how opium was used by the British to break into Chinese markets. Everyone knew that opiates had a potential for addiction. Perdue was allowed to continue it’s lies and marketing campaign, while other pharma companies ran similar misinformation campaigns. the country used to have laws, yet they are no more. Many of the opiates that Perdue and other companies distributed were taken out of the supply chain, by the black market. These companies made sure that the DEA could not enforce the law. These opiates were never prescribed, yet they are still misleading the public about the role of doctors and patients.
    22 years and still they are using a public health crisis to market lies and products. 80 thousand people died last year from alcohol, and there is silence. People with intractable pain, along with many others will commit suicide this year, yet nothing meaningful is being done. Content marketers, quack peddlers, and the pharma industry will perpetuate more lies based on low quality studies and continue to mislead the public.

    This kind of deceptive corporate content marketing is killing people, yet in the interest of profit, they keep publishing it. For 22 years it is profits over people. We used to be able to trust sites like this to check the quality of the data they refer to, now only marketing is allowed.

    • T Trust!

      How about peddling your quackery somewhere else. Neoliberalism has led to marketing and lies instead of factual reporting is difficult. One of the most obvious solutions would be Universal Healthcare, and decent wages. A lot of “back pain’ could be cured if people did not have to continue working, and could take a day off. This article is misleading and deceptive. One reason for this continuing false narrative is that they want to conflate all workplace injuries and over work, with simple back pain. It is just how they conflated all people with pain and drug addicts. They deliberately conflated all opioid deaths, whether by prescription or illegal drugs, in order to mislead the public and stigmatize sick people. That was where marketers like yourself came in , to take advantage of people who are being misled or lied to.

  • Studies that conclude NSAIDS/Lyrica etc is superior treatment compared to opioids are often flawed. Example-low dose opioid compared to strong NSAID. Another example-Tramadol being used in the non opioid group. Credibility is diminished in the eyes of some when such studies are published.

    We often hear about the success in reducing opioid use but never hear from the people who are cut off. Those people should all be permitted to comment if they so choose. How are they doing? Are they suffering? Are they coping okay? Still employed? How is their family life? If they consent, we should hear from everyone willing to share and not just any person hand picked because he is one who may be doing well.

    I believe that Physiotherapy for low back pain is extremely important but ppl should not be denied essential medication if they need it. Patients should be educated about all the risks and benefits of all reasonable treatment options & paternalistic attitude needs to stop. Deaths among legitimate chronic pain patients are rare. It is those abusing illicit drugs who are dying.

    No one should be forced to put up with pain if they cannot tolerate it using other measures or if they need it in the short term. To leave one in pain is a violation of human rights. To deny patients who are in pain the right to Informed Consent by not informing them about the risks and benefits of opioids is discriminatory. They have the right to make decisions of importance over their own body and no one should be denying that right.

    Each and every one of us have the right to control what happens to our bodies and forcing a person to suffer when the medication is available to help them inhumane.

    We are competent to understand all reasonable treatment options. We are competent to understand the benefits and the risks of all treatment options. Please drop the paternalism. Control what happens to your own body rather than inflicting pain upon others by denying them the right to have pain brought to a level they can tolerate.

  • Until you have actually had two failed spinal fusions because of ongoing degenerate disc disease you have no right to write an article stating you have experienced back pain! When you have tried rounds of repeated physical therapy, exercises, massage, topical rubs including lidocaine, epidurals, nerve ablation, transcutaneous nerve stimulators……. There are people like myself that truly need opioids just to have any semblance of normalcy. I don’t like the side effects but opioids are the only way I can get out of bed everyday.

  • Interferential Therapy devices are the best way to manage pain with no medications. I’ve been providing them in the workers comp industry for almost 30 years.

    • Ms Newman,

      That is highl unlikely. One of the major problems here are the Content Marketers, profiteers like yourself that see discussions like this, as a good place for advertising their fraud based business. It is a Fact that if there was a “best” way to “manage pain” a lot of us would not be here commenting. Why don’t you join T Trust and compare notes on exploiting sick or desperate for cash money. Perhaps those acupuncture marketers pay better. Workers Comp has increased the amount of misinformation and lies on this topic, so they could avoid paying claims. The insurance industry is behind a lot of the lies and misleading propaganda. They pay journalists and people like you to misinform the public.

  • I have had a spinal fusion and still have back pain 5 years later. And I will for the rest of my life because of misinformed people like you. I’ve tried everything. Done everything. But because of the current atmosphere of opioid hysteria I can’t even get my pain treated. I’m told to take an Advil. Guess what? Advil doesn’t touch it. No therapies have helped. My back is deteriorating and I can’t stop it or treat it. Because of people like you that mistakenly assume opioids don’t help. We don’t expect them to cure the problem. We want to be able to function. That’s it. The cause if my pain CAN’T be cured. You honestly have no idea what we go through.

    • I know exactly how you feel. So do many people in my family. We have degenerative disc disease pretty bad in my family. And it starts attacking in the 20s for us.
      I have also seen my mother get physically addicted to the oxycontin for her back from pain management. The good thing was she had great will power and was able to detox thanks to a great surgeon. However the both of us will have pain for life. She’s now on her 4th fusion. I’m on my first finally thanks to a great surgeon who was very creative with testing.
      Some back pain can be cared for without pills like opioids. But not all and pt isn’t cheap now.
      I would love to see universal health care. I have friends in Norway with chronic pain and they are able to do so much more for them. Even on low incomes. It’s very sad to see people knock the system that would better suit a country with a dire need for more coverage. People are truly dying because they don’t have the money and it’s inhumane.

    • Thanks John!

      I have been tracking this since @1999. Our government has been taken over by industry interests, and at the same time, the public is not privy to many of the facts. Our media has only covered this in a really distorted way. For example the amount of Opiates, that were not prescribed is secret, these drugs were wholesaled to the black market. The DEA tried to intervene in 2002, but they were blocked. DEA investigators were fired. The Pharma companies filed Lawsuits against law enforcement. At the same time, they bribed congress and policy makers. The medical industry was silent, since they were benefiting too. This whole thing has been profitable for everyone from the Sacklers to the treatment industry.

      The insurers are cashing in too. Opiates are a lot cheaper than appropriate care, and the false narrative they are running about all of it, is increasing insurer profits.

      Our government is no longer functioning in any meaningful way, the healthcare sector alone shows the rampant dysfunction. We pay more for healthcare than any other first world country, and have much worse outcomes. That leaves too much profit, which gets churned back into bribes, lies, and propaganda, that helps the industries.

      My theory is that most of the news coverage of healthcare is content marketing. Even the research that gets covered by media, is mostly industry funded, and used for content marketing and hype. Sites like this and those credible appearing websites, have to please their advertisers.

      One of those DEA guys lost his job, back in the mid 2000’s, so apparently only people that speak up or attempt to enforce the law are punished. The DEA was looking into the drugs that were openly sold to the black market by the supply chains for the big box stores. This has nothing to do with pain patients, physicians or prescribing. Clever industry propagandists had the media misreport this problem. They wanted to target the anger at pain patients and addicts, instead of where it belonged.

      The only problem with Oxycontin itself was that fact that it contained high doses of opiates, much higher than the label stated, due to it’s timed release nature. Perdue lied about the abuse potential. No one in government reacted, the FDA and CDC were bought off. While millions of doses were diverted to the black market, pain patients were put under more and more scrutiny. Even though this did not improve anything, it did improve profits and deniability for health providers, insurers and pharma. Pain patients benefited from Oxycontin. The problem was that Purdue and pharma wanted to increase market share and profits, my marketing Oxycontin for everything else. It was beneficial for people with long term intractable chronic pain. It is possible that Perdue and the pharam industry were behind conflating Oxycontin, and Oxycodone, in order to confuse the public and protect their brand name. Most people don’t even know the difference.

      These industries even funded research by “Pain Psychologists” to keep up the charade. At the same time social media spread lies, misinformation and pseudo science. They turned this all into a marketing campaign. Walmart and other big box stores, that had already made billions, combined misinformation, marketing and “opiate awareness.” They even marketed drugs that were “alternatives” that did not work, but they were profitable. They marketed useless anti depressants, anti psychotics, and other drugs for pain, even though there was no evidence any of them worked. They effectively tortured patients, while the media misreported it. People died from painful terminal conditions without any pain relief at all. Post surgical patients were terrified, they were going to turn into craven drug addicts. Psychologists did not “Study” any of that, by design. Of course there was no industry funding for that kind of meaningful research.

      Even the psychologists saw a profit potential here, they got a lot of industry funding for misleading research, that the media amplified and misreported.

      Going after Perdue 22 years later is just another misleading publicity stunt. Americans assumed that the FDA was protecting them, but the only thing they were protecting was corporate profits.

      There was a problem with prescription drugs years ago, but that has morphed to illicit drugs, yet they are still conflating the two problems. Purdue and the pharma industry most likely started that false narrative.

      Dude! We had 2 Planes fall out of the sky, because our “government” placed an industry insider from the same company in charge of the only agency protecting us. This was a lot more visible than what is going on in healthcare, and people still put up with it. The industry decided that that Boeing could do it’s own quality and safety assessments. The same thing is going on at pharma and the FDA. We don’t need any stinkin regulations, health providers only report data they choose, that does not interfere with profits. The FDA buried thousands of complaints about medical devices, which they also marketed as an alternative to opioids. The FDA buried the complaints about Fentanyl too, when the patches were leaking. Even industry groups like the AMA, dragged their feet, on CEs for addiction, that way they could avoid liability. Even the ACA only covered addiction treatment for addicts who could afford treatment in Malibu, not millions of people on Medicare or Medicaid. Those people are still not getting treatment, or only have assess to church basement, faith based 12 step programs, which are proven to not work. Denial about the socio societal problems, is adding to the death toll too. . A lot of the so called addicts would give it up if they had hope for a future.

      This is the Market Driven System! Bwa Ha Ha!

    • Yep mavis, makes sense now. Its about the money. You also got me thinking that the people writing these articles are not even paying us any mind, and treating pain patients like a bunch of fools! Looks hopeless. Thanks for comment.

  • In an article referenced in this story the authors (Chen et al., JAMA Network Open, 2019; 2 (2): e187621 DOI: 10.1001/jamanetworkopen.2018.7621) indicate that most deaths due to opioids will be from those misusing illicit opioids. Additionally they state that half of all new users will begin with illicit opioids and reducing misuse of prescription opioids will probably reduce overdose deaths by only 3 to 5 percent.

  • Interesting article, but in my case, I disagree. Due to arthritis all around my pelvic area, knees & back (verified by x-rays & MRI’s), I have had severe lower back pain for 20 plus years. I have seen several orthopedic specialists in 3 cities, & had LOTS of physical therapy and back injections. Also, I purchased a mattress & pillows that were suggested to me. Nothing that I have tried in OTC pain relievers or patches helps for more than about 45 minutes. I have had one hip & one knee replaced in the hope that relieving pain in those areas would help my balance/walking, and therefore, my back pain. Since I had mild polio as a young child, several orthopedists think that I have post-polio syndrome. Due to the extent of my arthritis, no doctor has suggested back surgery. A combination of 1-3 back injections a year, PT, & 1-3 Norco 5-325 pills a day keeps me relatively mobile. And, I have actually been able to reduce the dosage and frequency of the opioid medication that I take over the years and have tried and stopped several other RX’s that specialists thought might help my pain level, but didn’t. Recently, I was ill(first a cold, then a sinus infection & then, the flu despite having had the “senior” flu shot this past fall) & in bed a good bit for several months—-I am in my mid-70’s, with 5 grand-children & visit a memory care facility often, so I get exposed to many things. While I was propped up by pillows & in bed 15-20 hours a day, I had almost no back pain. However, now that I am well & doing work around the house & yard, the back pain has returned & I will get injections shortly—I have to wait so that I can be off blood thinner (heart condition) & Celebrex for a while. I do not choose to live my life with no activity & confined to bed, so I choose pain medications & back injections that allow me to have a life. There are many other people out there, based on Facebook groups that I belong to, that are in similar situations. We have to make choices based on our reality.

  • Dave, I’m sorry to say that you and most people are not understanding this issue fully. I know alot of people experience back pain but, and I hate comparing…there are people like me who done roofing work over 20 years, or many other brutal jobs out their that have absolutely destroyed our discs and nerves! I put off using opioids for many years and suffered horrendously painful, sleepness nights. Then you have all the other poor souls who are victims of bad accidents, botched surgeries, cancers, illnesses, etc. Please don’t group us all together with minor to moderate pain sufferers. I don’t expect you or anyone else to believe us but…
    YES! Opioids are our last hope and the difference between having any kind of peace in our lives or misery. Again, I implore you to stop punishing pain patients.

    • I’m so glad other chronic pain patients like myself, spoke up. I’ve had 7 surgeries on my lower back including 2 spinal stimulators. I’ve had every type of injection and physical therapy. I take opioid pain medication everyday. I wouldn’t be able to function and get anything done otherwise. I’ve tried for 8 years to get disability yet get denied every time. I’ve tried going back to work several times over the years and I just can’t keep up on a full time basis. My job is very physically demanding and I’ve been doing it for over 25yrs.
      I’m tired of everyone else passing judgment and making decisions about MY healthcare and MY well being without involving me or looking at me as an individual and not just some “junky” . Trust me I’ve had pharmacy staff give me dirty looks and question every prescription I fill. I think it would be great if insurance companies would cover more physical therapy and acupuncture and chiropractic for those that it benefits. Please don’t forget there are those of us who will never get any better than we are right now (I’ve actually been told that).
      Maybe the rest of us should get together and write a book about what it’s like to be grouped in with every individual who’s ever had back pain and had everyone else make decisions about their treatment and medication without being asked or treated as an individual…

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