The guidelines are based on randomized controlled trials and systematic reviews on noninvasive pharmacological and non-pharmacological treatments of nonradicular low back pain.
Here are five key points:
1. The evidence-based clinical practice guideline, "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain," recommends treatment of acute or subacute low back pain with non-drug therapies.
2. Some of these non-drug therapies include superficial heat, massage, acupuncture or spinal manipulation.
3. The society recommends providers prescribe anti-inflammatory drugs or skeletal muscle relaxants if pursuing a drug therapy.
4. American College of Physicians suggests patients with chronic low back pain first try non-drug therapy 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.
5. Those chronic low back pain patients who have experienced no response to non-drug therapies should then take NSAIDs first, and then tramadol or duloxetine as second line therapy.
"Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose," said Nitin S. Damle, MD, MS, MACP, president, American College of Physicians.
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