Credit: USA Today
American College of Physicians Recommendations for 2017.
The American College of Physicians (ACP) recently developed guidelines to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.
Given that most patients with acute or sub-acute low back pain improve over time regardless of treatment, clinicians and patients should select non-pharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation. If pharmacologic treatment is desired, clinicians and patients should select non-steroidal anti-inflammatory drugs or skeletal muscle relaxants.
For patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic treatment with 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.
In patients with chronic low back pain who have had an inadequate response to non-pharmacologic therapy, clinicians and patients should consider pharmacologic treatment with non-steroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.
This latest recommendation by a respected medical organization is indicative of the paradigm shift occurring in the medical-industrial complex.
Mainstream medicine is recognizing and advocating less medication and intervention and more less, invasive, less toxic, complimentary medicine in the treatment and management of chronic health conditions.