If you have Low Back Pain try these steps first

Low back pain is a pervasive issue, ranking as the second leading cause of disability in the United States and the fourth worldwide. It consistently ranks among the top five medical problems prompting individuals to seek medical attention. The prevalence of low back pain contributes significantly to missed workdays and is a major driver of healthcare expenditures, making it a considerable public health concern.

Looking at two kinds of back pain

Let’s delve into the most prevalent forms of back pain: acute, lasting less than four weeks, and subacute, which extends from four to 12 weeks. Approximately 85% of cases fall under the category of “mechanical back pain,” encompassing issues like muscle spasm, ligament strain, and arthritis. A smaller percentage (3% to 4%) may be attributed to more serious conditions such as herniated discs, spondylolisthesis, compression fractures due to osteoporosis, or spinal stenosis. In rare instances, less than 1% of the time, back pain can be linked to inflammation, cancer metastases, or infection.

When individuals present with acute low back pain, the primary objective is to rule out potentially severe conditions through a comprehensive interview and examination. Imaging or lab tests are only pursued if a cause other than “mechanical” is suspected. However, in the majority of cases, the challenge lies in addressing a seemingly benign yet intensely painful, debilitating, and economically burdensome condition. The array of available treatments can be overwhelming, but identifying truly effective options is key.

Analyzing a range of treatments for low back pain

The American College of Physicians (ACP), the second-largest physician group in the U.S., recently updated guidelines for the management of low back pain. Its physician researchers extensively reviewed hundreds of published studies on non-interventional treatments for back pain, analyzing data on various medicines such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, benzodiazepines, antidepressants, anti-seizure medications, and systemic corticosteroids. The analysis also encompassed studies on non-drug treatments, including acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, behavior-based therapies, and spinal manipulation for low back pain.

The primary focus of the research was on measuring the effectiveness, usually assessed in terms of pain relief and physical functioning, as well as evaluating potential harms associated with these diverse therapies.

Drugs are not part of the latest recommendations for treating “mechanical” back pain

The American College of Physicians (ACP) made a surprising finding in its updated guidelines for the management of low back pain. For acute and subacute low back pain, the ACP strongly recommended that the best and safest treatments are not medications. The key recommendation is:

“Most patients with acute or subacute low back pain improve over time regardless of treatment and can avoid potentially harmful and costly treatments and tests. First-line therapy should include nondrug therapy, such as superficial heat, massage, acupuncture, or spinal manipulation. When nondrug therapy fails, consider NSAIDs or skeletal muscle relaxants.”

This recommendation is grounded in the understanding that most cases of mechanical back pain improve over time regardless of the treatment, and prescribing medications upfront may pose potential risks. The focus is on providing guidance for non-drug therapies like heat therapy, massage, acupuncture, or spinal manipulation, which are considered effective and unlikely to cause harm.

Even the nonprescription pain relievers are not risk free

Medications such as ibuprofen and naproxen may provide relief for acute and subacute low back pain, but they come with potential risks such as stomach inflammation, ulcers, bleeding, and kidney damage, especially in the elderly. Muscle relaxants can have sedative effects and interact with other medications, while benzodiazepines and opioids carry the risk of sedation, addiction, and impaired cognitive function. For acute and subacute low back pain, the potential risks of these medications often outweigh the benefits. Other medications like acetaminophen, steroids, antidepressants, and anti-seizure medications were not found to be significantly helpful for these types of back pain.

Here’s what the study couldn’t tell us

It’s unfortunate that the study did not include topicals like the lidocaine patch or capsaicin ointment, which can offer relief for some individuals with little risk. Additionally, the efficacy of over-the-counter topical therapies containing menthol and camphor compared to a placebo for low back pain would be interesting to explore in future research. It’s great that you plan to cover chronic low back pain in a future post, considering the guideline updates for that specific issue as well. Stay tuned for more updates on pain management guidelines and treatments.