How To Heal Lower Back Pain: New Guidelines Suggest Drug-free Options

On Monday, the American College of Physicians released updated guidelines that urge doctors to avoid medication as the first-line therapy for lower back pain-a departure from its previous guidelines.

For people with low back pain, options range from exercise and a massage to acupuncture, in which a medical professional places tiny needles in the skin at certain points on the body, to spinal manipulation in which your spine is adjusted. The organization noted that acetaminophen has been shown to be somewhat ineffective for treating severe low back pain.

These are the new recommendations coming out of the American College of Physicians.

Low back pain is one of the most common reasons for all physician visits in the U.S. Most Americans have experienced low back pain.

The guidelines state that clinicians should reassure patients that acute or subacute low back pain will usually improve over time, regardless of treatment.

Also, in 2004, the AAFP issued a clinical recommendation on the prevention of low-back pain, which concluded evidence was insufficient to recommend for or against routine use of interventions to prevent low back pain in adults in primary care settings.

Chronic lower back pain (more than 12 weeks) should initially be treated with practices like exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction. ACP emphasizes that physical therapies should be administered by providers with appropriate training.

Third, patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy.

Since opioids have such a high risk of addiction and accidental overdose, the ACP says they should be considered a last option for treatment. A database search yielded dozens of randomized controlled trials published from January 2008 through November 2016 that assessed pain, function, or harms of systemic medications for low back pain vs. placebo or another intervention.

According to the guidelines, people typically suffer from acute back pain, which lasts less than 4 weeks, subacute back pain, which lasts four to 12 weeks or chronic back pain, which lasts more than four months.

"For acute back pain, the analogy is to the common cold", Dr. Deyo said. And they should only be used "if the potential benefits outweigh the risks".