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 If the pain began recently, the guidelines recommend superficial
heat, massage, acupuncture or spinal manipulation. If patients wish
to take medication, they should use nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen, or skeletal muscle relaxants
prescribed by a doctor. Acetaminophen and steroids are not
recommended for low back pain, according to the guidelines.
But for chronic low back pain - defined as pain that's lasted more
than 12 weeks - the American College of Physicians (ACP) recommends
people hold off on medications.
The new guidelines apply to low back pain that does not radiate to
other parts of the body like the legs, said Dr. Nitin Damle of the
Alpert Medical School of Brown University in Providence, Rhode
Island, who is president of the ACP.
Patients with low back pain that radiates to other parts of the body
need further evaluation, he told Reuters Health.
Low back pain is one of the most common reasons people visit U.S.
doctors' offices each year, according to the ACP in the Annals of
Internal Medicine. About a quarter of U.S. adults report low back
pain at least one day during the previous three months.
"Most back pain is self-limited," said Damle. "It’s common, will go
away given enough time and patients can help themselves initially by
trying some heat and stretching before going to see a physician."
The new guidelines are based on a review of studies that looked at
the use of drug and non-drug therapies for low back pain. The review
did not look at creams or injections, however.
Based on the review, the ACP recommends that people who have been
suffering with chronic low back pain try non-drug therapies such as
exercise, acupuncture, mindfulness-based stress reduction, tai chi,
yoga, biofeedback, cognitive behavioral therapy or spinal
manipulation.
If those methods don't work, the guidelines say the next step should
be NSAIDs or the pain medications duloxetine, which is marketed as
Cymbalta, or tramadol, which is marketed as Ultram.
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Opioids should only be considered as last resorts, and only
prescribed after doctors discuss their risks and benefits with
patients.
"If you’re going to have to use opioids, use them in the smallest
dose possible with the least frequency and smallest prescription,"
said Damle.
The new recommendations are very reasonable, said Dr. Joel Press,
who is physiatrist-in-chief at the Hospital for Special Surgery in
New York City.
"Anything you can do with these non-pharmaceuticals that can get you
moving faster is going to get you better in the end," said Press,
who was not involved in crafting the new guidelines.
"I hope this reinforces to physicians and patients that a lot of
these non-pharmaceutical treatments can have a lot of success," he
told Reuters Health.
SOURCE: http://bit.ly/2kr2SUK Annals of Internal Medicine, online
February 13, 2017.
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