Exercise yes, pills no: Doctors unveil guidance for lower back pain

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The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and alternative non-drug approaches. (Stock image)
The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and alternative non-drug approaches. (Stock image)

If you have lower back pain, the last thing you should do is take prescription opiates.

That’s the gist of guidance released earlier this month by the American College of Physicians. The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and non-drug approaches, including heat, massage, acupuncture, spinal manipulation, yoga and mindfulness-based stress reduction, according to a release.

If those treatments don’t provide relief, patients should try non-prescription pain relievers such as NSAIDs, followed by drugs such as tramadol or duloxetine. Only only as a last resort, when the potential benefits outweigh the harms, should doctors prescribe prescription opiates.

A Wilmington acupuncturist applauded the ACP’s move.

“First of all it’s long overdue,” said Leon McKay, owner of McKay Healing Arts, 4916 Wrightsville Ave. “The first line of defense has been to go to painkillers.”

The ACP’s recommendations come at the intersection of two public health trends: a crisis in opiate addiction and widespread complaints about lower back pain. Almost 25 percent of American adults say they’ve had lower back pain at least once during the past three months, according to the release.

“Physicians should reassure their patients that acute and sub-acute low back pain usually improves over time regardless of treatment,” Dr. Nitin S. Damle, president of the ACP, said in the release. “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.”

The guidance, “Noninvasive treatments for Acute, Sub-acute and Chronic Low Back Pain” is based on randomized controlled trials and systematic reviews of noninvasive drug-based and non-drug based treatments of lower back pain, as well as review of randomized control trials and data from observational studies, according to the release.

The ACP issued recommendations for treating lower back pain in 2007. That guidance did not evaluate treatment such as tai chi or stress reduction based on mindfulness practices.

Joan Quigley is and interim assistant editor at Port City Daily’s sister site, wydaily.com. Before trying a new health or fitness regimen, you should consult with your doctor.