Background <p>In light of the “opioid epidemic” described in numerous occasions in the USA, the question of why opioid consumption is rising in cases of non-cancer pain has become increasingly more important.</p> Questions <p>Do patients experiencing pain always require opioids? Does the specific pain diagnosis to be treated influence opioid prescription? Is oxycodone really necessary?</p> Patients and methods <p>Using three different research approaches, patients with back pain admitted between 2010 and 2015 were followed up over 7&#xa0;years to assess the quantities of opioids prescribed in the intervening years.</p> Results <p>During the observation period 769 patients were treated. Of these, 267 had back pain (radicular and non-radicular). Over 50% of patients with pain at a&#xa0;university outpatient pain clinic (<i>n</i> = 403/769 = 52.4%) did not require long-term opioid treatment. The number of patients on opioids was reduced by 12.2% over the course of the study. In addition, the quantity of opioids taken by other patients was reduced below the critical threshold of 1200 mg daily equivalent dose (TÄD), and in 4&#xa0;patients even to&#xa0;“0”.</p> Discussion <p>Patients with back pain represent a&#xa0;more difficult group to treat than, e.g. those with neuropathic pain. This is demonstrated by the figures for patients who never received opioids or who were not receiving opioids at the end of the observation period (38.2% vs. 52.4%). Nevertheless, it is worth attempting to reduce their use. Furthermore, it appears that the drug (oxycodone), which has caused many problems in the USA, is not essential for pain management.</p> Conclusion <p>An attempt to reduce opioid use is advisable even in the case of back pain, which can be considered a&#xa0;difficult condition to treat.</p>