Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

Abstract

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).

Approach to low back pain in conservative societies and developing countries

“…Pharmacological therapy including acetaminophens, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and opioids should be the second line in low back pain management, especially in developing countries, as their side effects are not considered by the patients, putting them on their long term side effects [4]. Physicians, on the other hand, should take advantage of the placebo effect of these drugs by combining the safest drug acetaminophens with the more effective drugs NSAIDs, thus minimizing the harm of long term NSAIDs use.…”

“…These guidelines which are generally applicable in western societies are not fully applicable in conservative societies, mainly Middle Eastern societies. On the basis of our observation and clinical experience, we speculate that there is a considerable difference between current management of LBP in middle eastern countries and management recommended by recent evidence-based clinical practice guidelines [4,5]. In this study, we will discuss how to use the most recent guidelines in the management of low back pain in conservative societies.…”

“…The general approach to low back pain, including diagnosis and management, is generally defined by guidelines of the American College of Physicians (ACP) [4], and the National Institute for Health and Care Excellence (NICE) [5]. These guidelines which are generally applicable in western societies are not fully applicable in conservative societies, mainly Middle Eastern societies.…”

Management of Patients With Acute Lumbary Pain: Recommendations of Experts and Actual Practice

“…В 2010 г. был опубликован сравнительный анализ 15 клинических рекомендаций (13 национальных и 2 международных европейских), который показал, что они совпадают по основным позициям обследования и лечения пациентов [9]. Недавно были опубликованы рекомендации экспер-тов из Великобритании, Дании и США [10][11][12].Согласно этим рекомендациям при обследовании пациента следует установить наличие одной из трех воз-можных причин поясничной боли: 1) неспецифическая боль (скелетно-мышечная); 2) серьезная патология (пере-лом, опухоль, инфекция и др. ); 3) дискогенная радикулопа-тия, или поясничный стеноз.…”

“…В 2010 г. был опубликован сравнительный анализ 15 клинических рекомендаций (13 национальных и 2 международных европейских), который показал, что они совпадают по основным позициям обследования и лечения пациентов [9]. Недавно были опубликованы рекомендации экспер-тов из Великобритании, Дании и США [10][11][12].…”