Tuesday, February 28, 2017

New ACP's Guidelines For Treating Low Back Pain

The American College of Physicians has issued new guidelines for noninvasive treatment of low back pain, published in the Annals of Internal Medicine, on Feb 14, 2017. The guidelines focus on treatment of acute, sub-acute and chronic low back pain through non-drug therapies, including superficial heat, massage, acupuncture and spinal manipulation or chiropractic. Physicians in the past have been known to recommend non-steroidal anti-inflammatory drugs (NSAIDs), yet research has shown this to be ineffective for many low back pain sufferers causing prolonged use or leading to many patients seeking other forms of treatments. We can all agree that no one is suffering from back pain due to a lack of Advil of NSAIDs in their bloodstream.

Low back pain is the 2nd most common reason for visits to a physician in the US. Due to prolonged sitting in the workplace and other various factors, cases of low back pain in the United States seem to be growing at a staggering rate. About one-quarter of U.S adults reported symptoms of lower back pain lasting for at least one day in the past three months.

In general, if the pain lasts for less than four weeks is is termed acute, while it's deemed as sub-acute if it lasts for four to twelve weeks. Chronic lower back pain typically last for more than twelve weeks. 

“For treating chronic conditions of lower back pain, physicians should recommend therapies having lower potential threats and cheaper costs." "Doctors should rigorously avoid prescribing costly therapies, particularly those with substantial harms, such as opioids (as they may cause addiction and accidental overdose) and pharmacologic therapies that weren't really found to be effective,” writes Amir Qaseem, MD, PhD, MHA and ACP guidelines committee's chairman.

ACP reviewed randomized controlled tests and systematic reviews of studies demonstrating the potency of non-invasive, non-drug and drug therapies for low back pain to generate these guidelines. The research from ACP supports non-drug based techniques ranging from tai chi for chronic back pain sufferers to acupuncture and oriental medicine for acute lower back pain cases.

The evidence clearly discourages the use of acetaminophen (also known as Tylenol) as it is found to be ineffective in correcting the cause of pain and is the #1 cause of preventable liver failure in the United States. In addition, the guidelines recommend not to use opioids as they come with substantial harm, are addictive and may create further risks of accidental overdose. 

ACP strongly recommends following the below mentioned guidelines -

1. Physicians shouldn't prescribe costly treatments and tests to their patients. First-line therapy should include non-drug therapy such as superficial heat, massage, acupuncture, and spinal manipulation or chiropractic. In cases where the pain is affecting the patient's quality of life or activities of daily living NSAIDs or muscle relaxants can be suggested to the patient for short-term use.

2. Physicians should recommend patients suffering from chronic back pain to opt for physical therapy, exercise, acupuncture, multidisciplinary rehabilitation, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, spinal manipulation or chiropractic.

3. Consider NSAIDs only if non-drug therapy fails to show any positive outcomes. Consider tramadol or duloxetine as secondary treatments when other treatments render sub-optimal results. Cases that couldn't be treated using first and secondary therapies and wherein risks outweigh the benefits, the use of opioids can be considered, however, this must be the last option to treating back pain cases.

No comments:

Post a Comment