For lower back pain, take exercise, not pills

The US is facing an epidemic of opioid addiction that often begins with a prescription for ailments like back pain.
The US is facing an epidemic of opioid addiction that often begins with a prescription for ailments like back pain.PHOTO: ISTOCKPHOTO

New US guidelines say patients should stay active, try other therapies before taking drugs

NEW YORK • Dr James Weinstein, an American back pain specialist, has some advice for most people with lower back pain: Take two aspirin and don't call me in the morning.

The American College of Physicians (ACP) has just published updated guidelines that say much the same.

In making the new recommendations for the treatment of most people with lower back pain, the group on Monday disagreed with many doctors and changed its previous guidelines, which called for medication as first-line therapy.

Dr Nitin Damle, president of the ACP board of regents, said pills, even over-the-counter pain relievers and anti-inflammatories, should not be the first choice.

"We need to look at therapies that are non-pharmacological first."

The recommendations come as the United States is struggling with an epidemic of opioid addiction that often begins with a simple prescription for ailments like back pain.

LIKE COMMON COLD

For acute back pain, the analogy is to the common cold. It is very common and very annoying when it happens. But most of the time, it will not result in anything major or serious.

DR RICK DEYO, a spine researcher and professor at the Oregon Health and Science University in Portland, and an author of the new guidelines.

The new guidelines said doctors should avoid prescribing opioid painkillers for relief of back pain, and suggested that before patients try anti-inflammatories or muscle relaxants, they should try alternative therapies like exercise, acupuncture, massage therapy or yoga.

The guidelines also said steroid injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the- counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.

Dr Weinstein, who was not an author of the guidelines, said patients have to stay active and wait it out. "Back pain has a natural course that does not require intervention."

In fact, for most people with acute back pain - defined as present for four weeks or less that does not radiate down the leg - there is no need to see a doctor at all, said Dr Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, and an author of the new guidelines.

"For acute back pain, the analogy is to the common cold," he said. "It is very common and very annoying when it happens. But most of the time, it will not result in anything major or serious."

The ACP's change of heart matches others internationally.

In Britain, where National Health Service guidelines say general practitioners may consider prescribing non-steroidal anti-inflammatory drugs for lower back pain, The Telegraph said more doctors see exercise as a better alternative.

"Painkillers are an understandable response to a back problem but they should not be offered alone, and other interventions, such as exercise, are shown to be both cheaper and safer, so represent a better option," Mr Steve Tolan, head of practice at the Chartered Society of Physiotherapy, told The Telegraph on Monday.

And Sydney University researchers last week said patients taking commonly used non-steroidal anti- inflammatory drugs are 21/2 times more likely to suffer from gastro-intestinal problems such as stomach ulcers and bleeding.

Yet anti-inflammatory drugs, such as ibuprofen, offer "very limited" short-term pain relief, a new study's lead author, Associate Professor Manuela Ferreira, told The Sydney Morning Herald. "They do reduce the level of pain, but only very slightly, and arguably not of any clinical significance," she said.

NYTIMES

A version of this article appeared in the print edition of The Straits Times on February 15, 2017, with the headline 'For lower back pain, take exercise, not pills'. Print Edition | Subscribe