Wednesday, 15 February 2017

New ACP guidelines on noninvasive treatment of low back pain

New ACP guidelines on noninvasive treatment of low back pain The American College of Physicians (ACP) has published new clinical practice guideline on noninvasive treatments for acute, subacute and chronic low back pain in primary care. The guidelines recommend use of non drug therapies such as exercise, mindfulness, acupuncture or yoga before prescribing drugs, NSAIDs or muscle relaxants. The use of opioids has strongly been discouraged. Acute back pain has been defined as lasting less than 4 weeks, subacute back pain as lasting 4 to 12 weeks and chronic back pain lasting for more than 12 weeks. The three recommendations by ACP are as follows: • Recommendation 1: Nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence) should be selected by both physicians and patients. Nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants should be selected if pharmacologic treatment is desired (moderate-quality evidence). (Grade: strong recommendation) • Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation) • Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, NSAIDs should be considered as first-line therapy, or tramadol or duloxetine as second-line therapy. Opioids should only be an option in patients who have failed the above treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence) (Source: Annals of Internal Medicine, 14th February, 2017) Dr KK Aggarwal National President IMA & HCFI

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