NEW BACK PAIN GUIDELINES

NEW BACK PAIN GUIDELINES

New guidelines from the American College of Physicians (ACP) were just published this year in the Annals of Internal Medicine.

The ACP made the following strong recommendations:

• For patients with acute or subacute low back pain, first-line therapy should include nondrug therapy, such as superficial heat, massage, acupuncture, or spinal manipulation. If nondrug therapy doesn’t relieve the pain, consider NSAIDs or skeletal muscle relaxants.
• For chronic low back pain, consider nondrug therapy, such as 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.
• For chronic low back pain that does not respond to nondrug therapy, consider NSAIDs next. For second-line, consider tramadol or duloxetine. Consider opioids only in patients in whom first- and second-line therapy has failed, in whom the risk outweigh the benefits, and only after full discussion of the potential risks and benefits.

Chiropractic spinal manipulation (adjustment) is the non-pharmacological therapy of choice for many patients for all three phases of back pain acute, subacute, and chronic.  

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