American College of Physicians Issues Guideline for Treating Nonradicular Low Back Pain
Be still my heart! The America College of Physicians (ACP) decided to give Physical Therapists (and other “alternative” treatment options) a HUGE Valentine’s Day present by issuing new guidelines for the treatment of nonradicular low back pain.
Okay, did I lose you at “nonradicular”? That just means low back pain that is in your back and does NOT radiate down to your leg! Radicular low back pain is pain that begins in your back AND radiates down your leg. Radicular low back pain is caused by a pinched nerve in your lower back and there are different treatment recommendations for that!
The ACP did a comprehensive review of the literature and concluded that acute low back pain (lasting less than 4 weeks) and subacute low back pain (4-12 weeks) are best treated by heat, massage, acupuncture, or spinal manipulation. While heat can be done at home and acupuncture must be delivered by an acupuncturist, the terms “massage” and “spinal manipulation” as they are defined in this guideline are treatments delivered here at Physical Therapy for everyBODY. Two out of four options found in one location! For patients with chronic low back pain (longer than 12 weeks) the ACP recommended exercise, multidisciplinary rehabilitation, acupuncture, and mindfulness-based stress reduction. Again, “exercise” and part of the “multidisciplinary rehabilitation” are also treatments delivered here at Physical Therapy for everyBODY. You can receive the manual treatment and exercise treatment recommended by the ACP in one place by one person!
On the pharmacological side, acetaminophen was not effective versus placebo, NSAIDs are first line therapy drugs, tramadol or duloxetine are second line therapy drugs, and opioids are the last treatment option, which is only used for patients who have failed other therapies.
And surgery? Forget about it, says the ACP. There is no research to prove that surgery decreases low back pain.
So, if you have low back pain that does NOT radiate down to your leg, the ACP (which probably includes YOUR doctor) recommend that you see a Physical Therapist (or an acupuncturist if you prefer the non exercise route).
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