At any given time, 31 million Americans suffer from low back pain. In fact, low back pain is the leading cause of disability worldwide and one of the most common reasons for missing work.
With so many people living with this troublesome condition, medication used to be the recommended first line of defense for treatment. That included everything from over-the-counter (OTC) pain relievers like Tylenol® to muscle relaxants to opioid medications for pain relief.
However, the American College of Physicians® (ACP) recently published updated guidelines in the Annals of Internal Medicine® that offer a new approach:
Basically, walk it off.
What do the new guidelines suggest?
The ACP wants patients to stay active and wait for the pain to resolve itself. They also recommend alternative therapies for treatment, such as yoga and physical therapy.
Here’s a fast breakdown of each new recommendation depending on whether the patient has acute low back pain (less than four weeks of pain), subacute pain (lasting four to 12 weeks) or chronic pain (exceeding 12 weeks):
For patients with acute and subacute low back pain—which typically resolve on their own—the ACP recommends that a nondrug therapy be selected as an initial treatment, including:
- Behavioral therapy
- Electromyography biofeedback
- Low-level laser therapy
- Mindfulness-based stress reduction
- Motor control exercises (MCE)
- Multidisciplinary rehabilitation
- Spinal manipulation
- Superficial heat application to the affected area
- Tai Chi
If patients insist on taking something, physicians are recommended to suggest nonsteroidal anti-inflammatory drugs (NSAIDs) or a muscle relaxant for a short period of time.
For chronic low back pain, patients should seek out the drug-free therapies listed above to alleviate pain.
For patients with chronic low back pain who have failed to find relief from nondrug therapies, NSAIDs should be given as the first line of therapy and opioid medication as the second. Opioids should be considered by physicians only when the benefits offset the risks for individual patients, and all other options have failed.
What was the purpose of updating the guidelines?
The partial update to the 2007 ACP guidelines follows the results of several trials and reviews published through November 2016 regarding drug and drug-free treatments for all types of low back pain. It should be noted, however, that the updated guidelines do not address topical remedies or epidural injection therapies (delivering steroids via needle into the epidural space in the spine to reduce inflammation).
These recommendations come as the country struggles with the epidemic of opioid addiction that frequently begins with ailments as simple as pack pain. According to the American Society of Addiction Medicine (ASAM), of the 20.5 million Americans ages 12+ that had a substance use disorder in 2015, 2 million of them had a substance use disorder involving prescription pain relievers.
What is the conclusion?
The long and the short of it is this in the eyes of the ACP: If you are a patient suffering from low back pain, you’re better off waiting it out because it will likely resolve itself. Talk to your physician about what treatment options may work for you.