Australasian Faculty of Occupational and Environmental Medicine
Recommendations from the Australasian Faculty of Occupational and Environmental Medicine on low back imaging, opioids, time off work and asbestos exposure. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) is a Faculty of the Royal Australasian College of Physicians (RACP) that connects and represents Occupational and Environmental Medicine Fellows and trainees in Australia and New Zealand.
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Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
Studies demonstrate that prescribing opioids for workers suffering back injuries is correlated with significantly longer periods of disability and a higher risk of surgery. Some of these relationships may be attributable to the higher likelihood of opiate prescription for people with more serious injuries. However, other studies have documented that long-term opioid use for chronic pain is associated with serious risks such as abuse and dependence, overdose, myocardial infarction, and motor vehicle crashes. These risks may outweigh the benefits given there is also insufficient evidence on whether the pain relief provided by opioids is sustained in the long term.
The use of opioids can result in euphoria, drowsiness or inability to concentrate, so using opioids is incompatible with many jobs. Thus, opiate prescription for the treatment of acute or chronic pain should not be initiated without first assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and their capacity to perform safety-critical activities.
Supporting evidence
- Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain – United States. Recommendations and Reports 2016; 65(1):1–49.
- Franklin GM, Stover BD, Turner JA, et al. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort. Spine 2008; 33(2):199–204.
- National Opioid Use Guideline Group (NOUGG). Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. 2010.
- Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine 2007; 32(19):2127-32.
How this list was made
The College worked with the President and EVOLVE Lead Fellow of AFOEM to compile and refine a list of nine recommendations regarding low-value clinical practices in occupational and environmental medicine. This initial list served as the basis for an online survey. Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. Based on the ranking of the initial nine, and the review of newly suggested items, these five low-value practices and interventions were chosen.
- 1 Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.
- 2 Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.
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Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
- 4 Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties.
- 5 Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.