From the CBS News Review:
New guidelines from the American College of Physicians say the first line of therapy should be non-drug treatments. For pain lasting less than three months, those include heat wraps, massage, acupuncture and spinal manipulation (hey, that is what we do here at the office, combined with Active Release Technique). The authors stress that clinicians should avoid costly and potentially harmful treatments like narcotics.
For pain lasting more than three months, treatments include stretching and strengthening exercises, tai chi, yoga, acupuncture, and mindfulness techniques like meditation to relieve stress.
If those fail, anti-inflammatories such as ibuprofen should be considered first, then medications that can dull nerve pain, like tramadol or duloxetine.
“Some of these treatments such as yoga or massage are often offered outside the traditional healthcare system,” said Dr. Steven Atlas of Massachusetts General Hospital, who wrote an editorial about the guidelines.
“Some of these guidelines may be a shot across the bow to insurers to say that maybe we should be covering them better,” Atlas said.
From the Wall Street Journal Review:
The new guidelines could influence how doctors treat patients with complaints of back pain. They are an update from 2007’s and include a review of more than 150 studies. Recommendations were broken down into acute and subacute lower back pain, which is pain lasting less than 12 weeks, and chronic pain, which is pain lasting more than 12 weeks. They don’t apply to radicular low back pain, sometimes referred to as sciatica, which is caused by compression of the nerves in the spine and can result in leg pain.
For acute and subacute pain, the guidelines recommend nondrug therapies first, such as applying heat, massage, acupuncture or spinal manipulation, which is often done by a chiropractor. If a patient requests drugs, the first line of treatment should be nonsteroidal anti-inflammatory drugs (NSAIDS)—over-the-counter, such as Advil, or prescription, such as celecoxib (brand name Celebrex), or muscle relaxants, such as cyclobenzaprine (brand name Flexeril).
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