No More Pain Meds for Low Back Pain
ACP Shuns Pharmaceuticals for Uncomplicated Back Pain
As of February 14, 2017, the American College of Physicians (ACP) will not endorse pharmaceutical usage as first line treatment for uncomplicated (non-radicular) low back pain.1 The new evidence-based clinical practice guideline was published in the Annals of Internal Medicine and recommends that “physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.”
Evidence Renders Drug Therapy Ineffective
The evidence has shown that drug therapies are not effective in improving low back pain outcomes as placebo, and that low back pain generally resolves within 4 weeks regardless of treatment. Systemic steroids are also admitted in the new guideline rationale as not being effective in this regard. These new guidelines are in alignment with public health concerns regarding opioid over-prescription and mismanagement, as well as dominant research in neurological origins of pain and pain resolution.
ACP Recommends Non-drug Therapy and More
The guidelines even address the management of chronic low back pain in similar fashion, recommending a multidisciplinary approach. For patients with chronic pain complaints, the ACP recommends, “initially selecting 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.”1
For patients that have an inadequate response to non-drug therapy, NSAIDs should be used as first-line drug-therapy, and opioid consideration should be considered as a last resort.
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A ClinicalPractice Guideline From the American College of Physicians. Ann Intern Med. 2017.
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.