New Guidelines for Low Back Pain

PLEASE TAKE OUR POLL - IT'S IN THE LEFT COLUMN

The American College of Physicians and the American Pain Society, in an attempt to provide consensus in an area of therapeutic diversity, have elaborated guidelines on the treatment of low back pain. They are published in the Annals of Internal Medicine; here’s a summary of the summary:

1. The doctor should take a careful history and do a physical exam to determine if the back pain is musculoskeletal, associated with nerve damage, or possibly related to another serious condition.
2. If it’s musculoskeletal, there’s no routine need for X-rays, CT, or MRI scans. In other cases, the most appropriate test should be done. MRI (or CT) should be done only if surgery or an epidural steroid injection is planned.
3. The doctor should explain the available information on low back pain – the cause(s), how it’s likely to get better, and self-management of the acute phase – remain active, heating pad, exercise. First-line meds for pain are acetaminophen (Tylenol®) and anti-inflammatory drugs like ibuprophen (Advil®, Motrin®) or naproxen (Aleve®).
4. If there is no improvement, patients may consider non-drug therapies that have been shown to offer benefits in some cases: rehabilitation exercises, massage, spinal manipulation, acupuncture, yoga, and cognitive-behavior therapy.

The formulators of the guidelines want to emphasize that they are “only guidelines”, i.e. they are not intended to override the doctor’s judgment. I get the occasional “Hexenschuss” (an illustrative German name meaning a “witch’s shot” in the back), and I can attest that the approach makes sense.