Treatment Guidelines for Chronic Lower-Back Pain

While some people with lower-back pain may doubt whether movement is the answer, new treatment guidelines from the American College of Physicians (ACP) recommend nondrug therapies as the first line of treatment to relieve acute, subacute and chronic lower-back pain.

Fitness professionals frequently work with people with lower-back pain, and mind-body interventions are high on the list of recommended activities. In the U.S., lower-back pain is one of the most common reasons for all doctor visits, and approximately 25% of adults have had lower-back pain for at least 1 day in the past 3 months. For people with acute or subacute back pain, the new treatment guidelines recommend superficial heat, acupuncture, massage or spinal manipulation. For people with chronic back pain, initial recommendations include exercise, tai chi, yoga, progressive relaxation and mindfulness-based stress reduction, among other nondrug approaches. A systematic review of randomized controlled trials and other reviews provided the research support for the new guidelines.

The report advocates that drug therapies should not be considered until after other nonpharmacological methods have been tried. “Physicans should reassure their patients that acute and subacute back pain usually improves over time regardless of treatment,” said Nitin S. Damle, MD, MS, MACP, president of the ACP, in an ACP news release. “Physicans should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.”

The guidelines are available in the Annals of Internal Medicine (2017; doi:10.7326/M16-2367) and are public.