Here are the three recommendations:
1. Use nonpharmacologic treatment with superficial heat, massage, acupuncture or spinal manipulation. Clinicians can also prescribe pharmacologic treatment such as nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants. The organization notes most patients with acute or subacute low back pain experience improvement over time regardless of treatment type.
2. Choose from the following treatments for patients with chronic low back pain — nonpharmacologic treatment with exercise; multidisciplinary rehabilitation; acupuncture; mindfulness-based stress reduction; tai chi; yoga; motor control exercise; progressive relaxation; electromyography biofeedback; low-level laser therapy; operant therapy; cognitive behavioral therapy; or spinal manipulation.
3. Clinicians can select pharmacologic treatment with nonsteroidal anti-inflammatory drugs as a first-line therapy for patients exercising chronic low back pain who have not had an adequate response to nonpharmacologic therapy.
For a second-line therapy, clinicians can prescribe tramadol or duloxetine. The ACP notes opioids should only be an option for patients that have not responded to the above treatments and only if clinicians deem the potential benefits surpass the associated risks. If opioids are the final option, patients should have an in-depth conversation with their provider on appropriate use.
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