Most of us suffer back pain at some point in our lives. In fact, it's one of the most common reasons people go to the doctor. Many of us also probably reach for medication. Now, new guidelines from the American College of Physicians say try exercise, yoga, or massage first.
That's a pretty big change for both doctors and patients, but a welcome one, some doctors say.
To come up with the recommendations, researchers analyzed more than 150 studies looking at what works and what doesn't when it comes to lower back pain.
The type of acute pain we're talking about is your "garden variety back pain you might get after shoveling a little too much or over-exercising," says ACP president Dr. Nitin Damle — not the kind of pain that radiates down your leg and causes numbness, or the type which results from a major accident.
In contrast to other types of pain, Damle says acute back pain usually goes away on its own. "The body will adjust, the inflammation will go down," he says. It may take a few days or even a week, but eventually you'll be back to normal.
So why risk side effects of medication, he says, if you don't have to? Side effects can include gastritis, stomach upset and a rise in blood pressure.
Instead, the new guidelines suggest techniques to speed up the healing process, including heat wraps, massage, acupuncture and spinal manipulation which can "relax the muscles, joints, and tendons so people can be relieved of their low back pain sooner, rather than later."
Other options that can help include exercise, "mind-body" therapies like yoga, tai chi, mindfulness-based stress reduction and guided relaxation techniques.
For patients with chronic pain who just aren't responding to these non-drug therapies, the guidelines recommend medication to reduce inflammation such as ibuprofen and naproxen, which are nonsteroidal anti-inflammatory drugs (NSAIDs).
Acetaminophen doesn't reduce pain or inflammation and is no longer recommended for back pain, according to a review published in Annals of Internal Medicine on Tuesday. In certain cases, muscle relaxants might help short term.
If that fails, and pain persists, the next option could include medications for nerve pain or narcotics for pain. "Only in rare circumstances should opioids be given," Damle says, "and then only at the lowest dose possible and for the shortest period of time."
Primary care doctor Steven Atlas, an associate professor at Harvard Medical School who practices at Massachusetts General Hospital, wrote an editorial accompanying the guidelines. He describes them as a needed change. "We are moving away from simple fixes like a pill to a more complex view that involves a lot of lifestyle changes," he says.
Atlas says this is a big cultural shift. In order to make non-drug treatments more commonplace, he suggests doctors expand their referral systems and that health insurance companies consider covering these costs.
The guidelines were published online Feb. 13 in the Annals of Internal Medicine.
RACHEL MARTIN, HOST:
Lower back pain - yeah, you know who you are. You're not alone, though. Most of us will suffer from lower back pain sometime in our lives. And when it happens, many of us will reach for pain medication. But new guidelines from the American College of Physicians say don't do it. You're supposed to try yoga or acupuncture. Now, before you roll your eyes, listen to Patti Neighmond's report.
PATTI NEIGHMOND, BYLINE: Your back is killing you. You really want pain relief. But not so fast, says Dr. Nitin Damle, president of the American College of Physicians. In contrast to lots of other pain, he says, acute back pain - not the chronic kind - usually goes away.
NITIN DAMLE: The body will adjust, and it'll heal. And the inflammation will go down pretty much on its own.
NEIGHMOND: It may take a week or even 10 days, but there are things you can do, other than medication, to speed the process along.
DAMLE: Superficial heat, massage, acupuncture, spinal manipulation really is adequate for treating this problem.
NEIGHMOND: Exercise like yoga and tai chi can relax muscles, joints and tendons.
DAMLE: So that people can, you know, be relieved of their low back pain a little bit sooner rather than later.
NEIGHMOND: Techniques that distract people from pain, like mindfulness and purposeful relaxation, can also help. Bottom line - if not needed, why risk the side effects of medication?
DAMLE: They can give you gastritis. They can give you stomach upset. They can raise your blood pressure.
NEIGHMOND: Now, if non-drug treatments just aren't working and pain continues, the guidelines suggest medication to reduce inflammation and, in some cases, low-level painkillers. Primary care doctor Steven Atlas with Massachusetts General Hospital says the guidelines are a needed change.
STEVEN ATLAS: It's moving away from simple fixes to a more complex view that how to make the back better involves a lot of lifestyle changes that a pill isn't going to solve.
NEIGHMOND: Regular exercise can strengthen core muscles and protect the back. And powerful painkillers, like opioids, should be considered only as a last resort.
Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.