New Treatment Guidelines Stress Non-Drug Interventions for Back Pain
In a recent NW-T’s article, doctors are increasingly starting to prescribe activity in combination with a wait-and-watch approach for back pain patients.
On 14 February, the American College of Physicians also issued updated treatment guidelines for acute, subacute and chronic low back pain, now sidestepping medication as a 1st-line treatment and recommending non-drug therapies instead. This is a significant change, and one that could potentially save thousands of lives by avoiding opioid addiction.
The new guidelines include 3 primary recommendations, all of which focus on alternative treatments and physical activity, leaving painkillers as a very last resort.
Even in the rare case when an opioid is given, it should only be prescribed in the lowest dose and for the shortest duration possible.
Steroid injections and acetaminophen are also discouraged, as studies suggest neither is helpful or beneficial. Acetaminophen does not lower inflammation, and a review of the research11 shows steroids are on par with placebo when it comes to treating back pain in the long term.
1. “Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat … massage, acupuncture, or spinal manipulation … If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants …
2. For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction … tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation
3. In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy.
Clinicians should only consider opioids as an option in patients who have failed the aforementioned 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 … ”
According to Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University and one of the authors of the new guidelines, there’s really no need to see a doctor at all for acute back pain, defined as pain that lasts up to 4 weeks and does not radiate down the leg.
He likens it to a case of the common cold, most of the time you simply have to wait it out.
If you have sciatic nerve pain, certain stretching exercises can be helpful. Sciatica results when your sciatic nerve gets pinched in your lower back. The pain is typically felt as originating in your buttock, radiating down your thigh. Your sciatic nerve runs through your piriformis, a muscle located deep in your glutes.
If the piriformis gets too tight, it can impinge the sciatic nerve, causing pain, tingling, and numbness in your leg.
Oftentimes, simply stretching your piriformis may be enough to reduce this pain.
Keep in mind that part of staying active includes avoiding sitting as much as possible and practice yoga 3X a week.
While you may be more drawn to lying down rather than standing and moving around, the latter is likely to be more beneficial. I can vouch for the effectiveness of this strategy.
I suffered from low-back pain for many years from a riding accident and tried lots of treatments.
Nothing got to the root of the problem, until I learned about yoga, and the hazards of sitting and began standing more.
This was an unexpected pleasant surprise.
Be aware that the pain may indeed worsen initially. It did for me. But once I reduced my 8 hours of daily sitting to less than 3 hours, and did 30 mins of yoga, it vanished.
Eat healthy, Be healthy, Stand-up, Live lively.