New ACP guideline: begin with drug-free approach to low back pain

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  • Nonpharmacologic therapies should be used as first-line treatments for acute (<4 wk), subacute (4-12 wk), and chronic (>12 wk) low back pain.
  • If nonpharmacologic therapies do not work, then NSAIDs are the first-line pharmacologic therapies.
  • Acetaminophen is ineffective at relieving low back pain.

Why this matters

  • Around 25% of US adults report low back pain lasting at least 1 d in the prior 3 mo.

Study design

  • The American College of Physicians (ACP) conducted 2 evidence-based reviews of randomized controlled trials.
  • The reviews served as a springboard for the clinical practice guideline and a video message from the ACP President.
  • Funding: Source undisclosed.

Key findings

Acute and subacute low back pain

  • Most patients will improve over time irrespective of treatment.
  • First-line nonpharmacologic therapies include massage, superficial heat, acupuncture, or spinal manipulation.
  • NSAIDs or skeletal muscle relaxants should be used if pharmacologic treatment is preferred.

Chronic low back pa...