For acute neck and low back pain, including pain after a car accident, the CDC's 2022 prescribing guideline states that nonopioid therapies are at least as effective as opioids for many common types of acute pain. National data also show that opioid use and dosage rise sharply among people whose spinal pain has become high-impact. I do not prescribe medication. I explain this evidence to patients in Charlotte so they can have an informed conversation with the clinician who does.
What the CDC Guideline Says
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain covers adult outpatients with acute pain lasting under a month, subacute pain lasting one to three months, and chronic pain lasting longer (Dowell, MMWR Recomm Rep 2022). It was built with the GRADE framework from systematic reviews.
Its first recommendation is that nonopioid therapies are at least as effective as opioids for many common types of acute pain. The guideline's implementation notes name low back pain, neck pain, and pain from musculoskeletal injuries such as sprains and strains among those conditions. Its second recommendation is that nonopioid therapies are preferred for subacute and chronic pain. When opioids are used for acute pain, the guideline calls for immediate-release opioids at the lowest effective dose and no longer than the expected duration of pain severe enough to need them.
The CDC also states that the guideline is not meant to be applied as an inflexible standard, and that patients with pain should receive appropriate treatment that weighs the benefits and risks of every option.
What the National Data Show
A RAND analysis of national survey data from 2003 to 2015 looked at people with chronic neck and back pain (Herman, Spine 2019). Among those with high-impact chronic spinal pain, meaning pain that restricts work, social life, or self-care, 48.4% used spine-related opioids, compared with 12.4% of those with low-impact pain. Average daily opioid dose was more than five times higher in the high-impact group. Opioid use and dosing increased significantly across the years studied.
That study does not show that opioids caused pain to become high-impact, or the reverse. It shows that the two travel together, which is one reason the early weeks after an injury matter.
Nonopioid Options
The CDC lists nonpharmacologic options for pain that include exercise, manual therapies, and spinal manipulation, alongside nonopioid medications such as anti-inflammatory drugs. Which of those fits a given patient depends on the diagnosis, which is why the workup comes first.
A Safety Note
If you already take an opioid, do not stop or change it on your own. Talk with the clinician who prescribed it.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read the published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient by Dr. Justin Dick, DC.
Frequently Asked Questions
Are opioids the best treatment for neck or back pain after a car accident?
The CDC's 2022 guideline states that nonopioid therapies are at least as effective as opioids for many common types of acute pain, naming low back pain, neck pain, and sprains and strains (Dowell, MMWR Recomm Rep 2022).
How common is opioid use with chronic back and neck pain?
Among people with high-impact chronic spinal pain, 48.4% used spine-related opioids, compared with 12.4% with low-impact pain (Herman, Spine 2019).
What does the CDC recommend for subacute and chronic pain?
Nonopioid therapies are preferred for subacute pain lasting one to three months and for chronic pain.
Does Dr. Justin Dick, DC prescribe opioids?
No. Dr. Justin Dick, DC in Charlotte, NC does not prescribe medication. He explains the evidence so patients can discuss options with their prescribing clinician.
Should I stop my pain medication after starting chiropractic care?
Do not stop or change an opioid on your own. Talk with the clinician who prescribed it.
Where can I get nonopioid care for neck and back pain after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Wy, Ste 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95. PMID 36327391. LinkEvidence tier: Federal clinical practice guideline (GRADE methodology)
- Herman PM, Broten N, Lavelle TA, Sorbero ME, Coulter ID. Health care costs and opioid use associated with high-impact chronic spinal pain in the United States. Spine. 2019;44(16):1154-1161. PMID 31373999. LinkEvidence tier: Descriptive analysis of national survey data (MEPS 2003-2015)
About the author. Dr. Justin Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as a field doctor for Life, Sherman, and Palmer chiropractic colleges. ORCID: 0009-0001-2794-2159.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Research by Dr. Justin Dick, DC
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
- Our team
- Press
- Book your evaluation
- Contact Clear Life
Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Wy, Ste 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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