If you have lower back pain, the last thing you should do is take prescription opiates.
That’s the gist of guidance released Tuesday by the American College of Physicians. The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and non-drug approaches, including heat, massage, acupuncture, spinal manipulation, yoga and mindfulness-based stress reduction, according to a release.
If those treatments don’t provide relief, patients should try non-prescription pain relievers such as NSAIDs, followed by drugs such as tramadol or duloxetine. Only only as a last resort, when the potential benefits outweigh the harms, should doctors prescribe prescription opiates.
A Hampton Roads tai chi instructor hailed the move.
“We’ve been advocating that for years,’ said Phillip Szpiech, an instructor at Bending Tree Tai Chi Kung, 1716 Pleasure House Rd. in Virginia Beach. “I’m glad to see they’re catching up.”
Still, he struck a note of caution.
“Tai chi is certainly not a miracle exercise by any means,” said Szpiech. “But it does a lot for almost everybody.”
The ACP’s recommendations come at the intersection of two public health trends: a crisis in opiate addiction and widespread complaints about lower back pain. Almost 25 percent of American adults say they’ve had lower back pain at least once during the past three months, according to the release.
“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” Dr. Nitin S. Damle, president of the ACP, said in the release. “Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose.”
The guidance, “Noninvasive treatments for Acute, Subacute and Chronic Low Back Pain” is based on randomized controlled trials and systematic reviews of noninvasive drug-based and non-drug based treatments of lower back pain, as well as review of randomized control trials and data from observational studies, according to the release.
The ACP issued recommendations for treating lower back pain in 2007. That guidance did not evaluate treatment such as tai chi or stress reduction based on mindfulness practices.