[et_pb_section bb_built=”1″ admin_label=”section”][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][et_pb_text admin_label=”Text”]
Table of Contents
From simple heat wraps to physical therapy — before resorting to medication, according to new treatment guidelines.
Low back pain is among the most common reasons that Americans visit the doctor, according to the American College of Physicians (ACP), which released the new guidelines on Monday.
The recommendations put more emphasis on nondrug therapies than previous ones have. They stress that powerful opioid painkillers — such as OxyContin and Vicodin — should be used only as a last resort in some cases of long-lasting back pain.
Another change: When medication is needed, acetaminophen (Tylenol) is no longer recommended. Recent research has shown it’s not effective for low back pain, said Dr. Nitin Damle, president of the ACP.
The good news, according to Damle, is that most people with shorter-term “nonspecific” low back pain improve with simple measures like heat and changes in activity. Nonspecific pain, Damle explained, is the kind where your back hurts and “you’re not sure what you did to it.”
He said that’s different from “radicular” back pain, which is caused by compression of a spinal nerve — from a herniated disc, for example. Typically, this problem has telltale symptoms like pain that radiates down the leg, or weakness or numbness in the leg.
In general, the ACP said, people with low back pain should first try nondrug options.
Research suggests heat wraps, massage, acupuncture and spinal manipulation may ease pain and restore function to a moderate degree, according to the guidelines.
If the pain lasts more than 12 weeks, studies suggest some drug-free options can still be helpful, the ACP said.
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 (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve) — or possibly muscle relaxants.
If that fails, and pain persists, the next options might include duloxetine (Cymbalta) — which is prescribed for both depression and nerve pain. Or the painkiller tramadol, which is a narcotic, but it can relieve pain and affect function in the short term, according to the guidelines.
“Only in rare circumstances should opioids be given,” Damle said. “And then only for a few days.” That’s partly because of the risks of opiate painkillers, he said, which include addiction and accidental overdose.
Besides that, Damle added, there’s “little evidence” that opioids help people with low back pain. The recommendations, published online Feb. 13 in the Annals of Internal Medicine, are based on a review of studies looking at what works — or doesn’t work — for various stages of low back pain.
In many cases, the ACP found, the therapies — drug or not — showed “small” to “moderate” benefits.
When it came to radicular back pain, specifically, there was little evidence on what worked. But exercise therapy seemed to help.
That advice is “reasonable,” said Dr. Steven Atlas, a primary care doctor at Massachusetts General Hospital and associate professor at Harvard Medical School.
Atlas, who wrote an editorial published with the guidelines, noted that all medications — including NSAIDs and muscle relaxants — can have side effects. And some patients, particularly older adults, may not be able to take them safely.
Still, Atlas said, the recommendations will probably be a big change for many primary care doctors.
In the real world, he noted, a doctor may not have a list of acupuncturists to refer patients to, for example. And then there’s cost.
“In everyday care, it gets a lot more complex,” Atlas said. “From the patient’s perspective, it’s, ‘What’s available in my area? What does my insurance cover?’ ”
Damle agreed that people’s treatment decisions will depend largely on those practical issues.
Atlas made another point about real-world practice: Doctors often recommend combinations of therapies, rather than a single one.
He said there’s a need for more “pragmatic” clinical trials that test back-pain therapies as they are commonly prescribed in practice.
For now, Atlas suggested people with mild back pain try to “de-medicalize” the problem and focus on simple self-care.
For people with chronic pain, he said it’s important to be realistic about whatever therapy you try.
“If you expect to have zero pain afterward, most of our therapies will disappoint,” Atlas said.
The guidelines only address noninvasive treatments for low back pain — and not invasive procedures like medication injections or surgery.
The question of when people should resort to those, Atlas noted, is the “elephant in the room.”
SOURCES: Nitin Damle, M.D., president, American College of Physicians, Philadelphia; Steven Atlas, M.D., associate professor of medicine, Harvard Medical School, and physician, general internal medicine, Massachusetts General Hospital, Boston; Feb. 13, 2017, Annals of Internal Medicine, online
News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.
Sourced From: Try Drug-Free Options First for Low Back Pain, New Guidelines Say
Copy Rights: MedlinePlus: Back Pain
For more information, feel free to ask Dr. Jimenez or contact us at 915-850-0900
By Dr. Alex Jimenez El Paso Chiropractor and Back Specialist
The information herein on "New Guidelines Say Drug-Free Options First For Low Back Pain" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.
Our information scope is limited to Chiropractic, musculoskeletal, acupuncture, physical medicines, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions.
We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.
Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.*
Our office has reasonably attempted to provide supportive citations and has identified the relevant research studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.
We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez, DC, or contact us at 915-850-0900.
We are here to help you and your family.
Presently Matriculated: ICHS: MSN* FNP (Family Nurse Practitioner Program)
Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
My Digital Business Card
For individuals experiencing eye problems, can acupuncture treatment help and benefit overall eye health? Acupuncture… Read More
Can physical therapy treatment protocols aimed at improving range of motion and flexibility around the… Read More
Can acupuncture treatment help individuals dealing with or experiencing insomnia and sleep issues and/or disorders?… Read More
For individuals training for long distance walking marathons and/or events, can focusing on building a… Read More