Latest guidelines from American College of Physicians:
“Most patients with acute back pain have self-limited episodes that resolve on their own; many do not seek medical care”
Don’t take drugs as your first approach to treatment, they advise.,
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)
Mayo Clinic says:
“Most acute back pain gets better with a few weeks of home treatment. Over-the-counter pain relievers and the use of heat or ice might be all you need. Bed rest isn’t recommended.
“Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don’t avoid activity out of fear of pain. If home treatments aren’t working after several weeks, your doctor might suggest stronger medications or other therapies.”
“You see the headlines of major sports stars getting an MRI tomorrow, so some high school athlete or college athlete or recreational athlete thinks if Derek Jeter got one why don’t I,” says J. C. Andersen, chair of the department of Health Sciences and Human Performance at The University of Tampa, Florida, who was not part of the new [ American College of Physicians]study.
“Tony Romo of the Cowboys got an MRI, but they’ve got lots of resources that the rest of us don’t have, and it may or may not have helped him get any better,” Andersen says.
Opioids should be ‘last option’ for treatment, says a story in Medicalnewstoday
Clinical trials reviewed in the guidelines show that acetaminophen does not reduce pain when compared with a placebo. Systemic steroids were also shown to be ineffective in treating acute or subacute low back pain. However, the evidence supporting this was deemed “low-quality” by the ACP.
The committee recommends that patients with chronic low back pain start by undergoing non-drug therapy and exercising, as well as engaging in multidisciplinary rehabilitation, acupuncture, mindfulness-based therapies for stress reduction, tai chi, and yoga.
Other practices recommended by the ACP in the initial stages of chronic low back pain include MCE (an activity that focuses on the “activation of the deep and global trunk muscles”) and progressive muscle relaxation, including the use of electromyography biofeedback. Biofeedback-assisted relaxation uses electronic devices to measure body functions, thus helping the patient gain control of muscle tension and relaxation.
The ACP also recommend low-level laser therapy and spinal manipulation, as well as cognitive behavioral and operant therapy.
The president of the ACP comments on the newly issued recommendations:
“For the treatment of chronic low back pain, physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another. Physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training.”
Dr. Nitin S. Damle
As the next clinical step for patients with chronic low back pain who did not respond well to nonpharmacological therapy, the ACP recommend nonsteroidal anti-inflammatory drugs, followed by drugs such as tramadol or duloxetine as second-line therapy.
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