ACP recommends non-invasive treatment for most low back pain
In February of 2017, the American College of Physicians released its evidence-based clinical practice guidelines for noninvasive treatment of subacute and chronic lower back pain.
Researchers conducted a rigorous, systematic review of the highest-quality randomized, controlled trials. They evaluated the effectiveness of non-surgical treatment, surgery, and drug treatment based on these outcomes:
- reduction of severity and recurrence of pain
- improved back-specific function
- disability reduction and ability to return to work
- patient satisfaction with post-treatment quality of life
- adverse effects from treatment
Since low back pain generally improves over time, doctors should avoid unnecessary tests and potentially harmful drugs, especially narcotics.
During the first twelve weeks of back pain, physicians and patients should initially consider non-drug therapies like:
- Physical therapy, including heat therapy and massage
- Spinal manipulation [chiropractic care]
Researchers found that acetaminophen and steroids were not effective for low back pain.
When chronic back pain lasts for more than twelve weeks:
Patients and physicians should consider combining treatments that integrate multiple therapies like:
- multidisciplinary rehabilitation
- spinal manipulation [chiropractic care]
- mindfulness-based stress reduction
- tai chi and yoga
- motor control exercise (MCE)
- progressive relaxation
- electromyography biofeedback
- low level laser therapy
- operant therapy
- cognitive behavioral therapy
If these non-drug treatments don’t provide enough relief, patients and physicians should consider NSAIDs as first-line drug therapy. Tramadol and Cymbalta may be considered as second-line therapy. Opioids should be considered only as a last resort when other treatments fail and the risks and harms for the individual patient have been fully discussed.
The full text of the study is available from the ACP. For more information, view the ACP’s press release on treatment of low back pain.
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