According to new guidelines recently issued by the American College of Physicians, physicians should avoid prescribing narcotics for acute lower back pain when possible.
Instead, doctors should recommend minimally invasive procedures aimed to treat painful conditions.
Low back pain is one of the most common reasons for doctor visits in the U.S. Approximately one-fourth of U.S. adults reported having low back pain lasting at least one day in the past three months.
In the evidence-based clinical practice guideline the American College of Physicians said if drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.
Acute pain is defined as lasting less than four weeks, subacute pain lasts four to 12 weeks and chronic pain lasts more than 12 weeks. Physicians should reassure their patients that acute and subacute low back pain usually improves over time and there are innovative treatments that can be performed to promote faster pain resolution. Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.
For chronic low back pain, the American College of Physicians initially recommends 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.
Physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training. 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.
Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability/return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction and adverse effects.
For more information, contact contact Comprehensive Pain Management in South Kingstown, RI.