Purestock/Thinkstock(NEW YORK) — The American College of Physicians has updated their current guidelines on treating low back pain – and there are some surprises.
Published in Annals of Internal Medicine, the ACP’s primary recommendation is to avoid using any drug-based treatment as a first option, and instead opt for non-drug approaches: exercise, rehab, acupuncture, mindfulness meditation, tai chi, yoga, biofeedback, spinal manipulation and cognitive behavioral therapy.
The authors of these guidelines looked to a systematic review, conducted by the ACP, that looked at those treatments and over-the-counter and prescription painkillers (acetaminophen –Tylenol– NSAIDs — Advil and Aleve– duloxetine –Cymbalta– tricyclic antidepressants, benzodiazepines and steroids). The authors examined how well all helped with short-term and long-term pain relief, function, and improvement in mood, as well as whether these patients would eventually need surgery.
They found acetaminophen and steroids were each ineffective for low back pain, NSAIDs had smaller benefit than a placebo for chronic low back pain, duloxetine was more effective than placebo, and TCAs were only as effective as placebo.
The authors also said that patients who don’t have an effective response to non-pharmacological therapy can then be told to use NSAIDs as first line therapy, with tramadol or duloxetine as second-line therapy.
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