OBJECTIVES: Although opioids are a well-accepted and effective method for pain management, it is still a challenge for physicians to find adequate treatment schemes in non-malignant pain. Inadequate treatment might impact quality of life and induce social and psychological problems. Aim of this survey was to describe treatment patterns of chronic back pain (CBP) in Germany. METHODS: In a cross-sectional, non-interventional survey n=4,283 German physicians were asked to report experiences with strong opioids in CBP. Statistical analysis was performed to analyze relationships between strong opioids and potential side effects. RESULTS: The majority of physicians (54.4%) at least partly accept strong opioid therapy in CBP noting treatment benefits in 69.6%. Most prescribed therapies are non-opioids like NSAIDs/COX-2 (55.1%) and physiotherapy (47.7%). 22.7% of all CBP receive strong opioids (26.0% fentanyl, 19.9% oxycodone/naloxone, 17.8% oxycodone, 13.9% hydromorphone, 13.8% burprenorphine, 13.7% morphine, 7.3% tapentadol, 1.8% L-methadone). 16.5% are treated in monotherapy, 23.6% with multimodal treatment. 67.5% show a reduction in pain intensity ≥50%. 25.8% need strong opioids for longer than 12 months. 26.2% need an increased dosage. Furthermore, 20.2% of patients experience a decrease in efficacy, which leads to opioid rotation (15.1%). 23.4% have persistent side effects (25.3% never, 46.4% temporary) wherefore 16.1% switch and 15.2% withdraw the treatment. Most side effects are observed near start of therapy, with constipation being the most common and resistant side effect (49.1%). After treatment discontinuation, pain status is considerable worsened in 34.3%. Correlation analysis shows that morphine has the highest probability of side effects when compared to oxycodone and oxycodone/naloxone. CONCLUSIONS: Although physicians see the medical need, CBP patients seem not to be overly treated with strong opioids. Obviously, morphine is not the treatment of first choice. Treatments chosen strongly depend on physician specialty. As anticipated, constipation is the most common and resistant side effect.