Back pain is one of the most common symptom-related reasons we seek physician assistance; in fact, 85% of Americans will experience an episode of mechanical low back pain at some point in their lives.[1] For decades now, the primary method of treating acute, subacute, and chronic low back pain has been to prescribe medication. However, last month, the American College of Physicians (ACP) published a set of guidelines emphasizing the use of non-drug therapies over drug prescriptions.[2] Though the application of such techniques is not a new concept, painkillers have provided a easier, more lucrative way for doctors and hospitals to treat back pain while eliciting a positive reaction from patients who see pills as a tangible cure.[3] As mentioned in our past blog posts on the opiod epidemic as well as patient satisfaction, curbing prescription painkillers and unnecessary tests is difficult in the current American medical environment, but necessary for the betterment of patients. So what does the ACP suggest? Below are the methods outlined by the new guidelines, methods which can hopefully lead to fewer opiod addictions and unnecessary costs for patients.

 

  • Be active: As the spine specialist Dr. Christopher J. Standaert points out, many people with chronic back pain tend to avoid their usual activities, shutting down out of fear that they’ll make their situation worse.[4] However, teaching patients to set goals and work toward returning to an active life is crucial for their physical as well as emotional health.[5] The ACP reports that for chronic low back pain, exercise can result in improvement in pain relief and function.[6] Yoga, tai chi, Pilates, and swimming all have the power to potentially decrease pain intensity, as well as give patients a confidence boost in their physical capabilities even before the pain has completely subsided.[7]
  • Partake in Therapy: Physical therapy provides many important benefits that parallel those mentioned above; having a guide who can help you learn how best to manage your pain while partaking in daily activities is crucial to the healing process. Additionally, psychological and relaxation therapy can improve pain intensity and functional status, helping patients with problem-solving, goal setting, cognitive pain control, and coping techniques.[8]
  • Other methods: Massage, acupuncture, spinal manipulation, and superficial heat were all mentioned in the ACP guidelines as alternatives to medication as well.[9] All can temporarily relieve pain, and the ACP’s studies found that a heat wrap provided more effective pain relief than ibuprofen after 1 to 2 days.[10]
  • Be patient: The most important thing a doctor can do is to assure their patients that they will get better no matter what treatment they try.[11] Rick Deyo, one of the authors of the ACP guidelines, says that acute back pain is like “a common cold […] It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious.”[12] Therefore, sometimes the best method can be to simply wait it out.

 

Though there are so many ways to combat pain, our first instinct is often to reach for a bottle of painkillers or call our doctors for prescriptions. Hopefully the ACP’s guidelines can help usher in a new era of alternatives to the drugs we’ve become so dependent on while improving quality of life for all

[1] Hills, Everett C, “Mechanical Low Back Pain,” Medscape, Feb. 3, 2017, http://emedicine.medscape.com/article/ 310353-overview

[2] “American College of Physicians issues guidelines for treating nonradicular low back pain,” ACP Newsroom, Feb. 14, 2017, https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain

[3] King, Steven A, “The Guidelines on the Treatment of Back Pain,” The New York Times, Feb. 17, 2017, https://www.nytimes.com/2017/02/17/opinion/the-guidelines-on-the-treatment-of-back-pain.html?_r=1

[4] Kolata, Gina, “Lower Back Ache? Be Active and Wait It Out, New Guidelines Say,” The New York Times, Feb. 13, 2017,  https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.html

[5] Ibid

[6] Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea, “Noninvasive Treatments for Acute, Subacute, and Chronic Pain: A Clinical Practice Guide from the American College of Physicians,” Annals of Internal Medicine, Feb. 14, 2017, http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

[7] Ibid

[8] Ibid

[9] Ibid

[10] Ibid

[11] Kolata, “Lower Back Ache”

[12] Ibid