Noninvasive treatment guidelines for acute, subacute and chronic low back pain
This week the American College of Physicians updated their recommendations and guidelines on what the most appropriate noninvasive (no injections or surgery) treatments are for acute, subacute, and chronic low back pain.
Recommendation 1:
For acute and subacute low back pain, the most appropriate treatments include.
Non-drug (pharmacologic) treatments (used first)
- Heat therapy treatments
- Massage
- Manipulation
Drug (pharmacologic) treatments
- Nonsteroidal anti-inflammatory drugs
- Muscle relaxants
Recommendation 2:
For chronic low back pain, non-drug (pharmacologic) treatments should be used first, and include
- Exercise (walking etc.)
- Rehabilitation exercises
- Mindfulness-based stress reduction
- Tai chi and/or yoga
- Exercises that work on control (motor control exercise)
- Relaxation exercises
- Electromyography biofeedback
- Low-level laser therapy
- Operant therapy
- Cognitive behavioural therapy
- Spinal manipulation
Recommendation 3:
For chronic low back, only individuals who have not found adequate relief from non-drug treatments (above) should use drugs.
Appropriate drug (pharmacologic) treatments
- Nonsteroidal anti-inflammatory drugs as first-line therapy
- Tramadol or duloxetine as second-line therapy
- Opioids should only be considered as an option in patients who have failed the above treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.
We also should not forget
- Eduction
- and advice.
