Back pain. It is debilitating. In the west, treatment has been an unmitigated disaster with the problem becoming more severe and expensive. Important new guidelines have been released in the Annals of Internal Medicine . What do they recommend? In short, try non-invasive therapies first. These include many of the treatments we include here at Sports N Spine, some of which we have written about over the past few years.
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)
In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned 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. (Grade: weak recommendation, moderate-quality evidence).
Of note, pain medication and drugs on the market do not work better than placebo for back pain. Paracetamol recently proved to be ineffective for back pain. Opioids provide very little benefit and come with a high risk of side effects, dependency or addiction. The same research team recently also conducted a meta analysis of the research for Non-Steroidal Anti Inflammatory medication. What resulted is consistent with a trend: NSAIDS were proved to be clinically ineffective for the treatment of back pain. The authors conclude, "There are no simple analgesics that help with back pain."
As evidence based practitioners, we here at sports and spine are up to date with current developments for the treatment of back pain. We encourage a safe, timely recovery from an episode of acute back pain, and have many tools at our disposal to help you recover from chronic back pain. It is a frustrating condition, however, we are here to help.