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New Study Recommends Best Treatments For Back Pain

One of the most difficult issues facing patients, medical providers, and claim managers is lower back pain from personal injuries. A recent study by the American College of Physicians (ACP) shows that non-invasive, non-drug therapies work best to alleviate pain.

Over 180 clinical outcomes were evaluated by the authors including 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 new guidelines apply to all types of minor, acute and chronic back pain. Claim practitioners should “red flag” any medical record showing drug therapies for back pain. Of particular concern are opioids, one of the most commonly prescribed medications for pain relief. These medications should only be considered for chronic back pain when other alternatives don’t work according to the guidelines.

The key recommendations quoted from the study are:

Recommendation 1:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select non-pharmacologic 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 (NSAIDs) or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

Recommendation 2:

For patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic 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)

Recommendation 3:

In patients with chronic low back pain who have had an inadequate response to non-pharmacologic 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)

For a full reading of the study in the Annals of Internal Medicine with all citations and references, please click here >>

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