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The Latest on Low Back Pain
Here’s an update on the ACP’s latest guideline on noninvasive treatment options for acute, subacute, and chronic low back pain.
The American College of Physicians (ACP) has published its latest guideline on noninvasive treatment of low back pain in the Annals of Internal Medicine.1 That guideline reviews the clinical evidence of the benefits-or lack thereof-of various therapies, and offers clinical recommendations.
What follows is a recap of the key changes since the previous guideline in 2007-and a pop quiz that summarizes 3 new recommendations.
Question 1:
Answer and Question #2 on Next Page »
The correct answer: E
Question 2.
Answer and Question #3 on Next Page »
The correct answer: E
Question 3.
Answer and Question #4 on Next Page »
The correct answer: A
Question 4.
Answer on Next Page »
The correct answer: A
What’s New in the New Guidelines?
√ The update showed that acetaminophen was no more effective than placebo for acute low back pain (low quality evidence).
√ Tricyclic antidepressants were found to be ineffective for chronic low back pain relative to placebo (moderate quality evidence).
√ There was a small improvement in pain intensity and function associated with duloxetine vs placebo (moderate-quality evidence).
√ This report also assessed mindfulness-based stress reduction, motor control exercise (MCE), taping, and tai chi.
o Mindfulness-based stress reduction was found to be effective treatment for chronic low back pain (moderate-quality evidence).
o Evidence to determine the efficacy of MCE, taping, and tai chi was insufficient.
√ Superficial heat was more effective for acute or subacute low back pain than placebo (moderate-quality evidence).
√ Neither ultrasound nor TENS was effective relative to controls (low-quality evidence).
KEY TAKE-HOME POINTS
o Systemic steroids were not beneficial and should be avoided-even for patients with radicular pain
o Opioids are a last resort, only after other measures have failed.
o Tricyclic and SSRI antidepressants were not found to be effective.
o Improvements in pain and function were small, regardless of intervention, often with no difference compared with controls
o Treatment is best based on patient preferences that minimize potential risks and costs.
References:
1. Qaseem A, Wilt TJ, McLean RM et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:514-530.
