Updated Treatment Guidelines for Low Back Pain

Low back pain is one of the most common musculoskeletal conditions in our society. The American College of Physicians recently released an updated guideline for the treatment of low back pain. This blog post will discuss the recommended treatment options for acute, subacute, and chronic low back pain. 

The low back pain treatment guidelines divided low back pain into acute, subacute, and chronic time frames. 

  • Acute low back pain is defined as pain that lasts for less than 4 weeks. 
  • Subacute low back pain lasts between 4 and 12 weeks.
  • Chronic low back pain lasts for more than 12 weeks. 

Treatments were also divided into non-pharmacologic and pharmacologic treatment options. Since low back pain is rarely caused by something life threatening, non-pharmacologic treatment options are recommended before seeking pharmacologic or surgical treatment options. 

Acute and Subacute Low back Pain

Acute and subacute low back pain cases usually improve over time without any treatment. Treatments that can help with acute and subacute low back pain can include superficial heat, acupuncture, massage, and spinal manipulation. 

If these non-pharmacologic treatments are not effective in decreasing low back pain, non-steroidal anti-inflammatory medication (ie. ibuprofen) and muscle relaxants can be prescribed. Acetaminophen (Tylenol) was not recommended for the treatment of back pain because it was no more effective than placebo. 

Chronic Low Back Pain

Chronic low back pain treatments can include a combination of: exercise, rehabilitation, acupuncture, mindfulness stress reduction, yoga, cognitive behavioral therapy (CBT), and spinal manipulation. 

If low back pain persists after non-pharmacologic treatments, a trial of non-steroidal anti-inflammatory medication and muscle relaxers should be prescribed followed by tramadol or duloxetine as a secondary option. Opioids should only be considered as a last treatment option when all other treatment options have been exhausted. 

In summary, low back pain should be treated with non-pharmacologic options before seeking pharmacologic ones. Acute and subacute low back pain cases usually improve without treatment, but a combination of heat, acupuncture, massage, and spinal manipulation can help with these cases of low back pain. 

Chronic low back pain cases should be treated with a combination of exercise, rehabilitation, acupuncture, mindfulness stress reduction, yoga, cognitive behavior therapy, and spinal manipulation. If non-pharmacologic treatments are ineffective, then non-steroidal anti-inflammatory medications and muscle relaxers should be prescribed. 

 

REFERENCE:

Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. [Epub ahead of print 14 February 2017]