New Guidelines Call for Gentler Approach to Back Pain Treatment

If you automatically reach for pain relievers when you feel a twinge in your back, you might want to rethink your approach.

New guidelines issued by the American College of Physicians recommend first treating acute or subacute lower back pain with non-drug therapies such as heat or massage. If drug therapy is necessary, physicians and patients should opt for nonsteroidal anti-inflammatory (NSAID) drugs over opioid-based pain medication, according to the recommendations.

Dr. Gina Lynem-Walker is a physician consultant with Blue Cross Blue Shield of Michigan. She said back pain is one of the most common reasons people go to the doctor, with upwards of 80 percent of people experiencing back pain at some point in their life. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks), and chronic (lasting more than 12 weeks).

“Most back pain is from inflamed muscles or ligaments which may result from heavy lifting, twisting, poor posture when sitting or lying in bed among other reasons,” Lynem-Walker said.

The majority of cases will go away with conservative treatment. Lynem-Walker stresses rest and refraining from strenuous activity as an important first step in treating back pain. Gentle massage and ice and heat therapy for a few days can also help, as well as gentle stretching through Tai Chi, yoga or meditation. If pain is chronic, physical therapy could be prescribed.

If you work a physically demanding job, Lynem-Walker recommends asking your employer for an ergonomic study of your workspace. This can help ensure that you’re not putting yourself at excessive risk for a back strain or injury. Wearing a back brace and learning proper lifting procedures is also advised. If acute pain develops as a result of your work, take a break for a few days – get a doctor’s note if necessary to allow time to heal.

If your job is not as physically demanding, you still might find sitting at a desk all day isn’t ideal for your back. You too might benefit from an ergonomic workstation study to determine if your desk height and chair are optimally positioned to support good back health. Lynem-Walker said standing desks might be a good option for some people when it comes to avoiding back pain at work.

If non-drug treatment isn’t offering relief, Lynem-Walker said NSAID treatment in conjunction with other non-drug pain relief methods could be effective. In extreme cases, the anti-depression drug Cymbalta can be used to decrease sensitivity to pain and some doctors might prescribe tramadol, which is an opioid. The guidelines recommend physicians “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.”

Lynem-Walker points out that research doesn’t always support the efficacy of opioids in treating pain, plus they carry a high risk for addiction.

“Unfortunately in our society, dependency on opioid medication has become a big problem,” she said.

Pain is sometimes caused by underlying issues such as osteoarthritis or a herniated disk. If pain persists, your doctor might call for an x-ray or MRI to determine if there’s something else to treat. Warning signs include numbness, tingling or weakness in extremities, problems with bladder function or fever that accompanies pain.

If you haven’t experienced back pain and want to avoid it in the first place, Lynem-Walker recommends the following:

  • See if your employer offers ergonomic workspace studies and book your appointment for one.
  • Make sure you lift heavy objects the right way.
  • Maintain a proper weight. Even mild or moderate obesity can contribute to back pain because of additional pressure on your spine and back muscles.
  • Eat a proper diet, with particular focus on bone-building calcium and vitamin D.
  • Walking and light weight lifting or resistance training are ideal in helping to build stabilizing muscles.

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Photo credit: Gabriel Garcia Marengo

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