HealthDay News — According to a new clinical practice guideline from the American College of Physicians (ACP) published in the Annals of Internal Medicine, first-line therapy for patients with low back pain should be simple non-pharmacological remedies — from heat wraps to physical therapy.
The recommendations are based on a review of studies of evidence for various stages of low back pain. In many cases, the ACP found, the therapies — pharmacological or not — showed small to moderate benefits.
In general, the ACP said, patients with low back pain should first try non-pharmacological options. For pain that has lasted fewer than 12 weeks, research suggests that heat wraps, massage, acupuncture and spinal manipulation may ease pain and restore function to a moderate degree.
If the pain lasts more than 12 weeks, studies suggest some non-pharmacological options can still be helpful, according to the guidelines. Those include exercise therapy; acupuncture; mind-body therapies like yoga, tai chi, mindfulness-based stress reduction, and guided relaxation techniques; and cognitive behavioral therapy.
When medication is used, the ACP advises starting with nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen — or possibly muscle relaxants. Acetaminophen is no longer recommended. Citing moderate-quality evidence, the guideline recommends opioids as an option only in patients who have failed all aforementioned treatments, and only if the potential benefits outweigh the risks.
Chou R, , et al. “Non-pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.” Ann Intern Med. 2017. doi: 10.7326/M16-2459. [Epub ahead of print]
Chou R, et al. “Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.” Ann Intern Med. 2017. doi: 10.7326/M16-2458 [Epub ahead of print]
Qaseem A, et al. “Non-invasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Ann Intern Med. 2017. doi: 10.7326/M16-2367. [Epub ahead of print]