Guidelines for the treatment of patients with low back pain
The second largest physician group in the United States, the American College of Physicians (ACP), recently published guidelines for the treatment of patients with low back pain.
ACP's guidelines, published in the Annals of Internal Medicine, make a progression of recommendations, detailing an array of treatments that doctors should consider during a patient's particuar phase of treatment.
Clinicians first treat sub-acute low back pain patients with non-drug therapies
In a very clear message that pharmacologic treatments should not be used at the outset of care, the guidelines recommend clinicians first treat sub-acute low back pain patients with non-drug therapies such as spinal manipulation, acupuncture, massage therapy, and others. Additionally, for patients with chronic low back pain, again, treatments such as spinal manipulation, exercise therapy and others, should be attempted first, per the guidelines. ACP finally recommends that only after an inadequate response to non-pharmacologic treatments should pharmacologic treatments be considered.
ACP explains their methodology as using their own grading system and "based [their] recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain."
The target audience for the guidelines was listed as "all clinicians" and the target patient population "includes adults with acute, subacute, or chronic low back pain."
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To read the guidelines in their entirety, visit the Annals of Internal Medicine article here.