Noninvasive Care for Low Back Pain

On this past Valentine's Day, the Annals of Internal Medicine, a respected medical journal, published clinical guidelines for low back pain. The guidelines are based on previously-performed studies of varying evidence qualities. They noted specifically that most low back pain does not require pharmaceutical intervention and can be helped with noninvasive treatment such as chiropractic care and massage. This continues the medical movement away from over-medicating conditions which can find resolution without major drugs or surgery, and confirms what we chiropractors see regularly: patients with low back pain improving every day.

Here are the main recommendations from the paper:

Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should 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. (Grade: weak recommendation, moderate-quality evidence)

I would add that although low back pain tends to improve over time in most patients regardless of treatment, it is also one of the highest-recurring conditions of the body. In other words, if you have had low back pain in the past, you're almost certain to get it again. This means that proper treatment is indeed necessary to strengthen the muscles of the low back, to properly align the spine, to protect your posture, and so on, to properly treat the condition and prevent its return for as long as possible. It is not appropriate to sit back, wait for the pain to go away, and then figure that you're just fine. When pain disappears, it doesn't automatically mean that everything's fine. Ongoing exercise, postural modifications, and even massage and chiropractic care can be a major benefit.