National medical group issues non-drug guidance for low back pain treatment

Practitioners should prescribe alternative therapies to patients with chronic back pain over painkilling opioids, according to new guidance from the largest physician group in the country.

On February 14, the American College of Physicians released a statement recommending physicians and patients should treat acute or subacute low back pain with non-drug therapies, such as superficial heat, yoga, tai chi, and acupuncture. Further, if drug intervention is required, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs), or skeletal muscle relaxants, recommends the group.

Low back pain is one of the most common reasons for all physician visits in the U.S., according to the American Chiropractic Association, who has recently done its own advocating for non-drug alternatives to opioids. Click here for a recent article on the subject. Most Americans have experienced low back pain, with approximately one quarter of U.S. adults reporting having low back pain lasting at least one day in the past three months, says the APC. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks, and chronic (lasting more than 12 weeks), says the group.

The ACP release is the latest recommendation that seeks to reframe how doctors and patients think about the prescription drugs, which are said to fuel a national addiction crisis. The recommendations from the Philadelphia-based physicians organization, published  in the Annals of Internal Medicine, are based on reviews of more than 150 studies. They find evidence to support practices like yoga for pain control. Most acute lower back pain eventually will go away on its own, the guidelines note, though multidisciplinary approaches work best to aid the healing process.

Here's what the ACP recommends in detail:

• For patients with chronic low back pain, physicians and patients should initially select non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.

• For patients with chronic low back pain who have had an inadequate response to non-drug therapy, physicians and patients can consider treatment with NSAIDs as first line therapy, or tramadol or duloxetine as second line therapy.

• Physicians 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.

Drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015, according to the American Society of Addiction Medicine. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers. By prescribing non-drug interventions, and teaching patients to take care of their bodies, integrative practitioners could help ease this growing issue.