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New clinical guideline from physician group touts non-drug treatment for low back pain

The guidelines were based on the ACP clinical guidelines committee’s systematic review of randomized, controlled trials and systematic reviews on noninvasive pharmacologic and nonpharmacologic treatments for low back pain published until April 2015.

“Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects,” the ACP said in its report.

The new guideline is designed for all clinicians and adult patients with acute, sub-acute and chronic low back pain.

In the guideline, the ACP recommends that patients with acute, sub-acute and chronic low back pain should first seek non-drug treatments to relieve their pain. For acute and subacute low back pain, the guideline recommends superficial heat, massage therapy, acupuncture or spinal manipulation.

For chronic low back pain patients, non-drug treatment options should include 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 behavioural therapy, or spinal manipulation.

Clinicians should only consider pharmacologic treatment for chronic low back pain if patients have responded inadequately to non-drug therapies.

“Clinicians and patients should consider pharmacologic treatment with non-steroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy,” the guideline recommends. Opioids should only be considered an option for patients who have failed “the above treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients,” it added.

The American Chiropractic Association welcomed the new guidelines from the ACP citing a “growing body of research” that points to the effectiveness of non-drug treatments for low back pain.

“The chiropractic profession has long advocated for doctors and patients to use a more conservative approach to treating low back pain,” said ACA president Dr. David Herd. “These new guidelines by the American College of Physicians support a growing body of research as well as increasing recognition in the health-care community regarding the value and effectiveness of non-drug approaches, such as spinal manipulation, for acute and chronic low back pain.”

The Canadian Chiropractic Association did not respond to this writer’s request for comment.