American College of Physicians recommends non-drug therapies for low back pain

The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published in Annals of Internal Medicine that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation.

Low back pain is epidemic in the nation with nearly 100 million sufferers that has led to the pandemic of prescription opioid painkiller abuse. Medical officials at the CDC and NIH as well as professional health associations have recently changed their guidelines to manage this back pain and opioid addiction. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks, and chronic (lasting more than 12 weeks).

On Feb. 14, 2017, the ACP updated its clinical guidelines on the management of back pain, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”

Overall, the ACP guidelines emphasize nondrug conservative “hands-on” treatments such as spinal manipulation and therapeutic massage as first-line treatments. The guidelines also state over-the-counter nonsteroidal anti-inflammatories or muscle relaxants should be considered only after nondrug therapy fails. The ACP guidelines strongly discourage the use of opioids for chronic pain as did the CDC guideline released last year.

If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants. However, the evidence showed that acetaminophen was not effective at improving pain outcomes versus placebo. Low-quality evidence showed that systemic steroids were not effective in treating acute or subacute low back pain. “Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose,” said Dr. Nitin Damle, president, ACP.

For patients with chronic low back pain, ACP recommends that physicians and patients initially select non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.

For more information, contact Dr. Wendy at haydenhealth@gmail.com.