CHARLESTON, SC (WCSC) - Doctors should now tell patients with low back pain to try to get better without drugs.
That advice from the American College of Physicians in just-released guidelines published in the Annals of Internal Medicine.
And for patients with chronic low back pain, doctors are being told to look for treatments with "the fewest harms and costs."
Facing the national problem of opioid addiction, the ACP reports, "Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose."
Patients and their doctors are being told to use superficial heat, massage, acupuncture or spinal manipulation as first option treatments.
The ACP says patients should be reassured that the pain usually improves over time, and doctors should avoid putting patients through expensive tests, and avoid prescribing potentially harmful drugs, especially narcotics.
Low back pain is common, with about one quarter of all adults reporting they've had low back pain at least one day in the past three months.
If patients want medication, the ACP recommends doctors first suggest nonsteroidal anti-inflammatory drugs, or NSAIDs or skeletal muscle relaxants.
For those with chronic low back pain, the ACP offers the same recommendations of non-drug therapy first, then NSAIDSs, followed by tramadol or duloxetine.