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The best therapy for low back pain

American College of Physicians issues guideline for treating nonradicular low back pain

– Acupuncture is the only recommend “the first line of therapy” in both acute and chronic low back pain.

Philadelphia, February 14, 2017 — The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

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

The evidence showed that acetaminophen was not effective at improving pain outcomes versus placebo. Low-quality evidence showed that systemic steroids were not effective in treating acute or subacute low back pain.

For patients with chronic low back pain, ACP recommends that physicians and patients initially select non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.

CBS News (2/13, LaPook) reports on its website that the American College of Physicians (ACP) released new guidelines that says “the first line of therapy” for chronic low back pain “should be non-drug treatments.” The new guidelines recommend “heat wraps, massage, acupuncture and spinal manipulation” for pain lasting less than three months, and recommend treatments such as “stretching and strengthening exercises, tai chi, yoga, acupuncture, and mindfulness techniques” for pain lasting more than three months.

Newsday (NY) (2/13, Ricks) reports, “The new guidelines emphasize that opioid” pain medications “should be considered only as a last resort.”

The New York Times (2/13, A21, Kolata, Subscription Publication) reports that in its recommendations, the ACP “did not address surgery.” Instead, “its focus was on noninvasive treatment.” In addition, imaging “scans… for diagnosis are worse than useless for back pain patients, members of the group said in telephone interviews.” Scan “results can be misleading, showing what look like abnormalities that actually are not related to the pain.” The new guidelines (2/14) were published in the Annals of Internal Medicine.