Non-drug treatment is best route with back pain
Most Americans experience back pain. Average annual medical expenditures for back pain in is $6,096, while annual medical expenditures for those without pain is $3,516.
Traditional health care has initially treated all forms of back pain with pain medications; analysis of health care research recently revealed this approach as inappropriate. American College of Physician guidelines now state that medicine should be the last resort used when all other treatments have failed. This is a reversal of the prior standard of care.
Why? Given that most patients with acute back pain improve regardless of treatment, physicians and patients should select non-drug treatment with superficial heat, massage, acupuncture, or spinal manipulation. If those treatments fail, medicines advised are NSAIDs (ex. Ibuprofen) or skeletal muscle relaxants (ex. Cyclobenzaprine).
For chronic low back pain, proven effective are exercise, physical therapy, acupuncture, stress reduction, tai chi, yoga, progressive relaxation, biofeedback, low-level laser therapy, cognitive behavioral therapy, or spinal manipulation. In short, chronic back pain should never be treated in the ER and only rarely in a physician’s office.
Fewer harms occur with non-drug interventions, the guideline states. Drugs do not change outcomes or recurrence, and rarely improve life quality. Patients with inadequate response to non-drug therapy should consider pharmacologic treatment with NSAIDs (ex. Ibuprofen) as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider adding narcotics after these treatments fail, and only if potential benefits outweigh the risks. This is opposite past standards of care.
The guideline states narcotics are associated with substantial harms and rarely benefit patients. Narcotics should be the last treatment option considered, avoiding short-acting narcotics. Adhering to this guideline will be difficult. We physicians hate being unable to “fix” our patients’ symptoms. But for this we need the patient’s patience.
Allan P. Frank, MD MS
Assistant Clinical Professor
MSU College of Human Medicine