Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain
Publication Date: April 1, 2017
Last Updated: March 14, 2022
Recommendations
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants. (SM)
565
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. (SL)
565
In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned 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. (WM)
565
Title
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain
Authoring Organization
American College of Physicians
Publication Month/Year
April 1, 2017
Last Updated Month/Year
June 5, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.
Target Patient Population
Patients with low back pain
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D059350 - Chronic Pain, D059408 - Pain Management, D001416 - Back Pain, D010146 - Pain, D059787 - Acute Pain, D017116 - Low Back Pain
Keywords
nonsteroidal anti-inflammatory drugs (NSAIDs), low back pain, low back pain (LBP), chronic low back pain
Methodology
Number of Source Documents
184
Literature Search Start Date
January 1, 2008
Literature Search End Date
November 1, 2016