Opioids should be last option for back pain treatment, new guidelines say

Opioids should be last option for back pain treatment, new guidelines say


In a nation that often seems divided on a long list of issues, there is one thing many of us have in common: An aching back. About 31 million Americans will have low back pain at least once during their lives, and the condition is one of the most common reasons for people missing work.

By some estimates, 25 percent of all Americans will spend at least one out of 90 days in bed with low back pain. While a painkiller might seem like a quick fix, the American College of Physicians has released new clinical guidelines that steer clear of that strategy. Pain is categorized as acute, lasting less than four weeks; subacute, lasting four to 12 weeks; and chronic, lasting more than 12 weeks. The ACP said physicians should reassure their patients that acute low back pain usually improves over time, regardless of treatment.

The group recommended that physicians should start treating patients’ chronic back pain by using superficial heat, massage, acupuncture or spinal manipulation. The next step should be exercise stress-reduction therapies such as tai chi and yoga. Other suggested practices include biofeedback-assisted relaxation, which uses electronic devices to stimulate muscle relaxation.

For those patients who do not respond well to these therapies, the ACP recommends nonsteroidal anti-inflammatory drugs. Opioid drugs, which can be addictive, should be a last-resort and used only when patients have failed the other therapies and only if the potential benefits outweigh the risks.

If you have lower back pain, talk to your physician or chiropractor about the many treatment options available.

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