Chronic back pain? New guidelines call for exercise, heat pads — painkillers a last resort

Got back pain? New guidelines offer tips on how you and your doctor can alleviate pain. Getty Images

You may be tempted to ask your doctor for prescription painkillers when you’re grappling with chronic back pain. But new guidelines suggest that drugs should be a last resort — you should be turning to exercise, massages, heat pads and stress relief first.

These are the new recommendations coming out of the American College of Physicians. Their guidelines suggest that painkillers shouldn’t be liberally doled out to people suffering from back pain.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment. Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients,” Dr. Nitin Damle, president of the ACP, said in a statement.

“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,” Damle warned.

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So what are the recommendations?

  • Don’t bother with acetaminophen – evidence suggests it isn’t effective at improving pain compared to a placebo. Other evidence suggests that systemic steroids weren’t effective either.
  • For people with low back pain, options range from exercise and massage to acupuncture, in which a medical professional places tiny needles in the skin at certain points on the body, to spinal manipulation in which your spine is adjusted.
  • Rehabilitation is also an option to help treat physical and psychological issues tied to back pain.
  • Yoga, Tai Chi and other exercises that zero in on strengthening back muscles also help.
  • If these methods don’t work, doctors can consider NSAIDS, or nonsteroidal anti-inflammatory drugs. Drugs, such as Tramadol or duloxetine are recommended as second line therapies.
  • Opioids are a final option if patients don’t get help from the other treatments, the recommendations say. And they should only be used “if the potential benefits outweigh the risks.”

What is considered low back pain?

Low back pain is an incredibly common reason why people show up at their doctor’s office. Statistics suggest that about one-quarter of people report low back pain lasting at least one day.

Some people dealing with low back pain also feel muscle weakness or a tingling sensation. In most cases, the pain subsides within a few days or weeks without treatment.

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Acute back pain is when the discomfort lasts for less than four weeks, subacute back pain lasts from four to 12 weeks and chronic back pain occurs for more than three months.

The guidelines are timely: in the past year, health officials worked tirelessly to turn the tide on opioid addictions.

See the full recommendations here.

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