Case studies

A 38-year-old woman with chronic low back pain

Rajiv Menon, Richard O’Regan



A pain physician and an addiction medicine specialist discuss the management of a 38-year-old woman with a 10-year history of low back pain who continues to experience significant pain despite taking high-dose opioids, diazepam and pregabalin.

Key Points

  • Establishing a good therapeutic relationship, excluding dangerous pathology early and involving multidisciplinary care early will help to optimise long-term outcomes for patients with chronic pain.
  • It is useful to consider whether the patient is primarily experiencing nociceptive pain, neuropathic pain or a mix of both types of pain.
  • The GP’s role in safer opioid prescribing can include monitoring for signs of overuse, considering using a treatment agreement, seeking the patient’s prescription history and performing urine drug screens.

    Picture credit: © F1online/Axel Leschinski/