September 28, 2017

New guidelines from the American College of Physicians (ACP) were just published this year in the Annals of Internal Medicine.
The ACP made the following strong recommendations:

• For patients with acute or subacute low back pain, first-line therapy should include nondrug therapy, such as superficial heat, massage, acupuncture, or spinal manipulation. If nondrug therapy doesn’t relieve the pain, consider NSAIDs or skeletal muscle relaxants.
• For chronic low back pain, consider nondrug therapy, such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive-behavioral therapy, or spinal manipulation.
• For chronic low back pain that does not respond to nondrug therapy, consider NSAIDs next. For second-line, consider tramadol or duloxetine. Consider opioids only in patients in whom first- and second-line therapy has failed, in whom the risk outweigh the benefits, and only after full discussion of the potential risks and benefits.