Diagnosing and managing lower back pain: New Guidelines from ACP/ACS
Earlier this month, a series of articles in the Annals of Internal Medicine covered the pharmacologic and nonpharmacologic management of lower back.
Systematic reviews [1,2] of English-language studies included in MEDLINE and the Cochrane Database of Systematic Reviews were conducted to assess the most common pharmacologic [2] and nonpharmacologic [1]interventions indicated for acute or chronic back pain. Based on these reviews, the American College of Physicians (ACP) and the American Pain Society (ACS) recommended a Joint Clinical Practice Guideline [3]. Some of the main points of the guideline are as follows:
Clinicians should conduct a thorough physical exam and medial history review to categorize patients into 1 of 3 broad categories, namely:
· “nonspecific low back pain
· back pain potentially associated with radiculopathy or spinal stenosis,
· back pain potentially associated with another specific spinal cause.”
In patients with nonspecific low back pain, imaging tecnhiques and other diagnostic tests shouldn’t be routinely used. These techniques should only be performed “when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination.” MRI seems to be the preferred method to check for radiculopathy or spinal stenosis while CT-scan is only recommended for patients who are “potential candidates for surgery or epidural steroid injection.”
Recommended first-line medications are paracetamol and NSAIDS.
Clinicians should also advise patients on effective self-care options as well as nonpharmacologic adjunct therapies like exercise, acupuncture, massage, spinal manipulation, yoga, or progressive relaxation.
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