Published: Fri, February 17, 2017
Medical | By Garry George

New guidelines issued for treating lower back pain

Those treatments include heat wraps, massage, acupuncture and spinal manipulation.

The vast majority of American adults will experience lower back pain at some point in their lives, and now a major organization is recommending that doctors treat it in a new way. Acute low back pain lasts less than four weeks, subacute lasts four to 12 weeks and chronic lasts more than 12 weeks.

At least that's the latest recommendation in a new study from the American College of Physicians. This kind of pain is very different from "radical" back pain, which is caused by a herniated disc or compression of a spinal nerve. The review did not look at creams or injections, however. The recommendations are automatically considered invalid or withdrawn if they are not updated every 5 years.

Don't bother with acetaminophen - evidence suggests it isn't effective at improving pain compared to a placebo. Low-quality evidence showed that systemic steroids were not effective in treating acute or subacute low back pain. (Grade: "weak recommendation, moderate-quality evidence)".

Chronic lower back pain (more than 12 weeks) should initially be treated with practices like exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction.

Professor Helen Stokes-Lampard, chair of the Royal College of Global Positioning System, added: 'Back pain causes considerable distress for many patients, and there is certainly no one size fits all solution, so further guidelines advocating a flexible approach to treating back pain make sense. Biofeedback-assisted relaxation uses electronic devices to measure body functions, thus helping the patient gain control of muscle tension and relaxation. ACP emphasizes that physical therapies should be administered by providers with appropriate training. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

The number of opioid overdoses and deaths in the United State is increasing at an alarming rate nationwide, prompting the ACP to release new guidelines recommending pain management methods that do not include drugs.

The guideline group said physicians should consider opioids as a therapeutic option only in patients who have failed the aforementioned treatments - and then only if the potential benefits outweigh the risks for individual patients - after a discussion of known risks and realistic benefits with patients.

For patients with chronic low back pain with inadequate response to nonpharmacologic therapy, consider pharmacologic treatment with NSAIDs as first-line therapy, or tramadol or duloxetine as second-line therapy.

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