The American College of Physicians (ACP) recommends that doctors avoid prescribing drugs, especially narcotics, for patients with acute or subacute low back pain. Patients should be treated first with non-pharmaceutical therapies, such as superficial heat, massage, acupuncture, or spinal manipulation. If drugs are needed, the evidence supports prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants. Acetaminophen was shown to be ineffective for acute low back pain.

The clinical practice guidelines and two evidence reviews are published in the peer-reviewed journal, Annals of Internal Medicine.

Low back pain is one of the most common reasons for patients to see a doctor and approximately one quarter of U.S. adults reported having low back pain lasting at least one day in the past three months. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks), and chronic (lasting more than 12 weeks). Acute and subacute low back pain usually improve over time regardless of treatment.

For patients with chronic low back pain, the ACP recommends non-drug therapy first. Exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low level laser therapy, cognitive behavioral therapy, and spinal manipulation are shown to improve symptoms with little risk of harm. The ACP emphasizes that physical therapies should, of course, only be administered by providers with appropriate training. Chiropractors are the experts in spinal manipulation, and the only providers licensed to perform spinal adjustments in the state of Tennessee.

Presented as a service to the community by: Union County Chiropractic Clinic, 110 Skyline Drive, Maynardville, TN (865) 992-7000 www.unioncountychiropractic.com.