Health Team

New back pain study recommends non-drug treatments

Posted February 21

Lower back pain is one of the most common ailments that sends people to the doctor, but new evidence from the American College of Physicians recommends a different treatment for some patients.

The clinical practice guidelines outline a radically different approach to previous recommendations: These guidelines, published in the latest edition of the Annals of Internal Medicine, say patients with new or relatively new onset back pain should not be treated with medications.

Instead, the doctors recommend non-drug therapies such as heat, massage, acupuncture or spinal manipulation.

If drug therapy is desired, physicians and patients should start with over-the-counter, non-steroidal anti-inflammatory drugs or muscle relaxants.

Most Americans have experienced some back pain sometime in their lives, and about 25 percent of Americans have experienced back pain at least one day in the past three months.

Studies show that acetaminophen, like Tylenol, is not effective in relieving back pain when compared to placebo. Oral steroids are also not shown to be effective in acute or sub-acute back pain. 

Narcotics should be avoided all together if possible. The Centers for Disease Control and Prevention recommends that when doctors prescribe narcotics, the prescription should be written for no more than three to four days to reduce the possibility of addiction or accidental overdose.

Instead, the study says patients with chronic lower back pain should begin with non-drug therapy, including exercise, acupuncture, tai chi, yoga, physical therapy rehabilitation, mindfulness-based stress reduction or spinal manipulation.

Because of the negative side effects of drugs, they should only be used if the non-drug therapy doesn't work.

Tramadol is an example of a second line therapy. Opioid narcotics are a last resort after the doctor has weighed in on the risks and benefits to the patient.

Some back pain, though, could be more serious than pain that's isolated to the area. Pain that shoots down into the lower leg might indicate some sort of nerve impingement that might require surgery or some more invasive treatment.

In general, WRAL Health Team's Dr. Allen Mask recommends fewer MRI and CT scans be done as now they are being overused. A good medical history and physical exam is the best place to start.

Often times, simple interventions like exercises, water therapy, local heat and a tincture of time relieves the pain. If the pain still persists, see a back pain specialist.


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