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Low Back Pain Guidelines

After reviewing the current research, the American College of Physicians (ACP) updated a 2007 guideline to suggest conservative treatments that includes spinal manipulation and exercise as the initial choice for low back pain patients.

Low back pain is one of the most common reasons for physician visits and approximately one quarter of U.S. adults reported having an episode of low back pain lasting at least one day in the past three months. Most episodes of acute low back pain improve within the first month. However, up to one third of low back pain patients report having discomfort one year later. Many pharmacologic and non-pharmacological treatment options are available for radicular (lower leg pain, numbness, and/or weakness resulting from nerve root impingement) and non-radicular low back pain.

Recommendation 1: Given that most patients with acute (less than 4 weeks) or subacute (4-12 weeks) low back pain improve over time, treatment options should include heat, massage, acupuncture, or spinal manipulation. If medication is desired, one should only use nonsteroidal anti-inflammatory drugs or muscle relaxants.

Recommendation 2: For patients with chronic (more than 12 weeks) low back pain, patients should initially try 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.

Recommendation 3: In patients with chronic low back pain who do not respond to conservative therapy, one should consider medications like nonsteroidal anti-inflammatory drugs first.

Some evidence has changed in the 10 years since the 2007 ACP guideline. The old review concluded that acetaminophen was effective for acute low back pain, but this recent update showed no difference between acetaminophen and placebo. Additional new evidence includes superficial heat to be effective for acute or subacute low back pain whereas ultrasound or TENS are shown to be not effective. Motor control exercises focusing on restoring the strength, control and coordination of the muscles of the spine have been shown to be effective in reducing pain and increasing function for chronic low back pain patients. These non-pharmacological interventions are considered as first-line options in patients with chronic low back pain because there are fewer side effects than with medication.

The next time you have low back pain, you may initially want to consider other options besides pain meds or muscle relaxants. At Lee Chiropractic Clinic, we offer spinal manipulation along with exercises that address restoring spinal motor control, strength and coordination.

Non-Invasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians

Annals of Internal Medicine 2017

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