With an emphasis on decreasing the use of opioids in the United States, the American College of Physicians (ACP) updated its guidelines for treating back pain. The new guidelines, keeping in-line with the Centers for Disease Control’s (CDC) position on opioid medications, strongly encourage clinicians to consider prescribing narcotics for their patients only as a last resort.
Low back pain affects close to two-thirds of Americans. The new guidelines emphasize that patients with acute and sub-acute cases (pain that goes away within 3 months) may find their pain improve over time without treatment of any kind. But not everyone has the ability to simply wait it out. In these cases, and when pain becomes chronic (pain that persists beyond 3 months), the ACP strongly advises physicians to avoid unnecessary tests and prescribing costly and potentially harmful drugs, especially narcotics. When it comes to low back pain the ACP recommends that non-invasive and non-drug therapies like acupuncture, massage, yoga, and other mind-body therapies should be the first line of treatment, and we agree!
Remember, chronic pain, including low back pain, is a symptom of inflammation. Without targeting the root cause of the inflammation and treating it, a person’s pain symptoms will not improve. Mind-body therapies, like the ones recommended by the ACP, help calm the inflammatory process in the body, promote healing, and present little to no risk.
Acupuncture – This 2000-year-old practice is thought to work by blocking pain messages to the brain with competing stimuli that cause an increase of endorphins, the body’s natural painkillers, and the secretion of neurotransmitters, which affect one’s perception of pain.
In 2007 the results of a large study of over 1,100 patients with chronic back pain was published in the Archives of Internal Medicine. After 10 treatments, the group that received acupuncture had a 47% improvement in pain and functioning after six months.
Massage therapy – A 2011 study concluded that people who were treated with massage therapy, whether relaxation massage or structural massage (deep tissue massage), for their chronic back pain saw benefits that lasted at least 6 months.
Yoga therapy – The poses, controlled breathing, and meditation involved in the practice of yoga can not only improve symptoms of chronic low back pain but can lower instances of depression and use of medication.
The ACP also recommends nonsteroidal anti-inflammatory drugs (NSAIDs) if drug therapy is desired or if patients have seen little improvement with non-invasive treatments. Occasional use of NSAIDs can certainly be helpful, but a big misconception about these OTC (over-the-counter) painkillers is that they’re completely safe and harmless. Regular use of NSAIDs can lead to problems with gut ulcers, liver damage and kidney damage. Ironically NSAIDs can even heighten one’s sensitivity to pain. People who take them more than once a week should discuss this with their physician.
A study released by the CDC showed drug overdose deaths in the United States have more than doubled since 1999, confirming the need for continued emphasis on the opioid crisis. ACP’s guidelines take the right approach; opioids should only be prescribed with close monitoring by the diagnosing physician, for the purpose of relieving pain and improving quality of life when all other medical approaches have been exhausted.
Bottom line: Whether you have an acute, sub-acute, or chronic case of low back pain, the first line of treatment should be a therapy that can help calm the body’s inflammatory process naturally and safely.
Will these guidelines be practiced? This responsibility lies in the hands of both the physician and the patient. When low back pain interferes with quality of life, talk to a physician about these wonderful and science-based therapies that can benefit your mind, body, and soul.