You may have heard that doctors are getting away from prescribing opioids for chronic low back pain. New guidelines from the American College of Physicians (ACP) advise doctors to start with options that don’t involve any type of medication.
This breaks from the World Health Organization tiered medication scale favored in the past. The scale previously focused on drugs that included opioids.
“We interpret the new guidelines as saying, ‘Try a number of non-pharmacological options before starting the use of long-term medication for low back pain.’ That’s a positive step,” says spine specialist E. Kano Mayer, MD.
While the ACP reviewed lots of studies to formulate its guidelines, he notes that it failed to look at how long each intervention was effective or at outcomes other than pain reduction.
“Cleveland Clinic spine specialists favor the active, rather than the passive, therapies recommended,” says Dr. Mayer. “We prefer that you do things actively to control pain and improve function, rather than waiting for things to be done to you.”
Cleveland Clinic spine experts support the following ACP recommendations, he says:
Cleveland Clinic spine specialists generally do not support the use of passive treatments for low back pain.
“Chronic use of low-level laser therapy, ultrasound, transcutaneous electrical nerve stimulation (TENS) and spinal manipulation may only help in the short term,” Dr. Mayer points out. “We don’t want you to waste your money on treatments unlikely to provide more than a day of benefit.”
If non-drug interventions don’t help, the ACP recommends first trying non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, indomethacin or meloxicam. While NSAIDs provide some pain relief, they may put you at risk for GI bleeding or kidney damage.
As second-line drugs, the ACP recommends duloxetine (an antidepressant) or tramadol (a novel opioid, but still subject to abuse).
Due to their serious side effects and addictive nature, opioid medications (morphine, oxymorphone, hydromorphone, tapentadol) should be used only as a last resort when patients fail all other therapies, the ACP advises. The rule of thumb: Use the lowest possible dose of opioid for the least amount of time.
If you’ve been suffering with long-term low back pain, it’s worth exploring these non-drug treatment options before resorting to pills. You’re likely to find your quality of life improving.