New Low Back Pain Guidelines Recommend Nonprescription Treatments First

The American College of Physicians (ACP) recently issued new clinical guidelines recommending that physicians avoid prescribing pain management drugs when treating acute or subacute low back pain. 

The ACP’s updated clinical practice guidelines, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” were developed based on an extensive review of the highest quality evidence available. These recommendations update guidelines published by ACP in 2007.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” Nitin S Damle, MD, MS, MACP, president of ACP, said in a press release. “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients” 

“Low back pain is one of the most common reasons for all physician visits in the United States,” Amir Qaseem, MD, PhD, vice president of clinical policy at ACP, and colleagues wrote in the guidelines.

As a result of ineffective treatments, ACP now recommends that physicians and patients initially select nondrug therapies including, superficial heat, massage, exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, cognitive behavioral therapy, or spinal manipulation. 

“For the treatment of chronic low back pain, physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another,” Dr Damle said.

According to the new guidelines, if nonpharmaceutical approaches to treatment fail, nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants are recommended.

The recommended prescription drugs also include Ultram (tramadol; Janssen) or Cymbalta (duloxetine; Eli Lilly) as second-line therapy. ACP stated that a clinician should only consider opioids as an
option in patients who have failed all prior treatments due to the risk of addiction. —Julie Mazurkiewicz