Prescribe exercise not drugs for lower back pain, say USA health chiefs

  • Prescribe exercise not drugs for lower back pain, say USA health chiefs

Prescribe exercise not drugs for lower back pain, say USA health chiefs

For those with chronic low back pain, the ACP offers the same recommendations of non-drug therapy first, then NSAIDSs, followed by tramadol or duloxetine. These therapies include exercise, physical therapy, acupuncture, meditation, yoga, low-level laser therapy, cognitive behavioral therapy, and spinal manipulation, all of which have been shown to reduce symptoms with little risk of harm.

Patients experiencing lower back pain should try heat wraps and exercise first, and only take prescription drugs as a last resort, a doctors' group recommends.

Don't bother with acetaminophen - evidence suggests it isn't effective at improving pain compared to a placebo.

At least that's the latest recommendation in a new study from the American College of Physicians.

That said, any person with low back pain that radiates down one or both legs, associated with weakness tingling or any associated fever, or fecal or urinary incontinence would not be included in such recommendations and should see their doctor for further management.

Since most patients with acute or subacute low back pain improve over time regardless of treatments, the ACP recommends that clinicians and patients select nonpharmacological treatment with superficial heat, massage, acupuncture, or spinal manipulation.

For patients with chronic low back pain, ACP recommends non-drug therapy first.

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The committee recommends that patients with chronic low back pain start by undergoing non-drug therapy and exercising, as well as engaging in multidisciplinary rehabilitation, acupuncture, mindfulness-based therapies for stress reduction, tai chi, and yoga. ACP said physical therapies should be given by providers with proper training.

For those with chronic back pain who find non-drug therapy unsuccessful, physicians should suggest ibuprofen or naproxen and only look to opioids as a last-case scenario, according to the guidelines.

The author of an accompanying editorial notes that these recommendations are likely to be a major change for primary care physicians.

"Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients", Dr. Damle adds.

Finally, the physicians should only prescribe opioids if the possible benefits clearly outweigh the risks.

"Most back pain is self-limited", said Damle. Systemic corticosteroids should also not be prescribed for these patients as they were not shown to provide benefit. They found tougher state laws cut the risk of death and led to less alcohol consumption overall.