Suffering patient touching his back in medical office
February 15, 2017

Don’t bother with pills if you have lower back pain

The American College of Physicians (ACP) has advised that medical doctors avoid prescribing drugs, particularly narcotics, for those suffering from acute or subacute low back pain.

Citing two evidence reviews it had published in Annals of Internal Medicine, the medical organization said patients should first be treated with non-pharmaceutical remedies, like shallow heat, massage, acupuncture, or spinal adjustment. If medications appear to be necessary, the ACP said prescribing nonsteroidal anti-inflammatory medications (NSAIDs) and skeletal muscle relaxants as the first options. The organization noted that acetaminophen has been shown to be somewhat ineffective for treating severe low back pain.

Massive Problem in the US

Low back pain is a very common reason for patients to see a doctor, and around one-quarter of US adults have reported the problem within the past three months. Pain is classified as acute, if it lasts less than four weeks, subacute if it lasts four to 12 weeks, and chronic if it lasts greater than 12 weeks. Acute and subacute low back pain generally gets better over time despite any medical care.

For those with chronic low back pain, ACP emphasized the use of non-drug therapy as a first option. These therapies include exercise, physical therapy, acupuncture, meditation, yoga, low-level laser therapy, cognitive behavioral therapy, and spinal manipulation, all of which have been shown to reduce symptoms with little risk of harm. ACP said physical therapies should be given by providers with proper training.

For those with chronic low back pain who do not respond to non-drug therapy, ACP suggested physicians and patients think about NSAIDs as next treatment option. Physicians should only think about opioids as last resort, the ACP said, for patients who have not responded to the previously mentioned treatments and just if the potential benefits exceed the risks associated with these drugs. Doctors prescribing opioids should also consult patients on the risks and benefits of opioid use, the ACP said.

Dr. Rick Deyo, a spine researcher at the Oregon Health and Science University and an author of the new guidelines, told the New York Times that low back pain, in most instances, doesn’t call for significant medical treatment.

“For acute back pain, the analogy is to the common cold,” Deyo said. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious. ”


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