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Back Pain Contribution to Opioid Crisis

Total Credits: 1 including 1 AOA Category 1-A Credit(s)

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State Associations:
OPSC - California
Dan Miulli DO, MA, FACOS
1 Hour 03 Minutes
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Patients with a chief complaint of back pain comprise a significant proportion of medical practices. These patients are referred in various stages of treatment; many of these patients are on opioid medications for varying times. More than 50% of regular opioid users report back pain. October 2017, the United States declared the opioid epidemic a National Public Health Emergency. Can offering intervention to these patients aid in ameliorating this epidemic by getting patients off opioids faster? Is there a difference between county versus managed care facilities in reduction of opioid medication?
Our study indicates that easy treatment is not associated with increase opioid usage but a significant decrease (P<0.05). The decrease in post-operative opioid usage is maintained whether the surgery is performed at a county or a managed care facility with the greatest reduction in the county hospitals and the least reduction in a managed care hospital. This reduction is due to easier health care access of patients in the managed care protocol driven setting and the resultant longer duration of medication therapy leading to an increased tolerance to opioids requiring higher doses over time.

Learning Objectives:
1. Describe the symptoms of low back pain
2. Describe the opioid epidemic
3. Describe the management of a person with low back pain
4. Describe the early treatment of a person with low back pain to limit opioids.

Disclosures: None Reported 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the American Osteopathic Association (AOA). The Osteopathic Physicians and Surgeons of California (OPSC) is accredited by the American Osteopathic Association (AOA) to provide osteopathic continuing medical education for physicians. 

Grievance Policy: OPSC strives to provide continuing medical education programs to fulfill the needs of the attendees and to meet the AOA Uniform Guidelines and AOA Accreditation Requirements. Comments, questions, or complaints should be forwarded to OPSC, by calling the OPSC Office at 916-822-5246 or by email to



Dan Miulli DO, MA, FACOS Related seminars and products

Dr. Miulli is a 1989 graduate of Midwestern University and completed his Neurosurgical Residency Training at Allegheny General Hospitals under Dr. Julian Bailes, receiving his diploma from Philadelphia College of Osteopathic Medicine in 1995. He is board certified in Neurological surgery with a fellowship in Skull Base and Microvascular Neurosurgery, and currently practices in Colton California. He is the Program Director of the largest AOA Neurosurgery Program. He has lectured both nationally and internationally on concussion and traumatic head injury and is the Senior Author of the best selling Thieme book Neurosurgical Intensive Care.

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