Drug-free therapies should be the first line of treatment against chronic back pain, new guidelines revealed Monday, Feb. 13.
Before being prescribed opioid medications, patients with lower back pain should try non-drug options such as yoga, acupuncture, mindful meditation, and tai chi, according to the American College of Physicians.
"I think most patients want medications as a fast fix. What patients understand is often far from what the evidence tells us to do," said anesthesiologist Anita Gupta, who was not involved in the study.
First Line of Treatment
Lower back pain is one of the most common reasons of doctor visits in the United States, the guidelines said. Because of this, the recommendations underline the importance of non-drug therapies, saying that powerful painkillers such as Vicodin and OxyContin should only be used as a last resort.
The new guidelines also suggested that when medication is required, acetaminophen or Tylenol should no longer be prescribed to patients. ACP President Dr. Nitin Damle said recent evidence indicates that acetaminophen is no longer effective against lower back pain.
On the other hand, Damle said most people with short-term "non-specific" back pain get better through simple methods such as heat and changes in activity.
Damle said non-specific pain is the kind of pain where your back hurts but you are not sure what you did to cause it. This kind of pain is very different from "radical" back pain, which is caused by a herniated disc or compression of a spinal nerve. Symptoms of radical back pain include pain that radiates down the leg or numbness and weakness in the leg.
How To Ease Lower Back Pain
The new guidelines suggest that for back pain that lasted for less than 12 weeks, drug-free therapies such as massage, acupuncture, heat wraps, and spinal manipulation may relieve pain moderately.
For pain that lasts for more than 12, weeks, exercise therapies such as acupuncture, yoga, tai chi, cognitive behavior therapy, mindfulness-based stress reduction, and guided relaxation techniques can still be effective, the guidelines said.
When medication is needed, the group advises nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen or muscle relaxants. If this does not work and the pain persists, however, the next line of treatment should include duloxetine or tramadol, which can relieve pain in the short-term.
Damle and his colleagues conclude that opioids should be given only in rare circumstance.
"And then only for a few days," added Damle.
The group's recommendations were published in the journal Annals of Internal Medicine.
