As of February 14, 2017 there is a new way advised for treatment of chronic back pain, and acute or sub-acute back pain. Updating the prior Guidelines issued in 2007, the new angle is that they are now going to move away from prescribing opioid pain medication, such as hydrocodone, OxyContin and Percocet. The American College of Physicians announced a new Clinical Practice Guideline for Low Back Pain that can be characterized this way:
- Be Active
- Wait it Out
Doctors Recommend Exercise and Patience Over Pain Medication
The Guideline recommends treatment without drugs for most patients. It recommends treatment with heat, massage, or acupuncture. Also recommended were exercise, physical therapy, tai chi, yoga, stress reduction mindfulness, and cognitive behavioral therapy. If these activities and therapies don’t work, the guideline recommends non-steroidal anti-inflammatory drugs such as Ibuprofen (Advil) or aspirin.
Acetaminophen (Tylenol) was specifically ruled out as ineffective, not better than a placebo (sugar pill) for this condition.
The Guideline reports that 25% of all US adults have experienced back pain in the last three months. The costs associated with this condition are monumental as they include not only costs of treatment but also lost wages and lost productivity.
New Guidelines Could Lead to Reduction in Opioid Drug Addiction.
Previously, (before this February 2017 Guideline), the typical approach to acute and sub acute back pain started with drugs for pain relief, and often included opioid pain killer medication. We now know that prescribing opioid pain medication for back pain often leads to follow on addiction to opioids. This is seen as a contributing factor to what has become an epidemic of opioid addiction across the US. According to Dr. Sanjay Gupta, doctors are uniquely positioned to lead the way out of this epidemic by prescribing safer medicines for their patients. See: http://www.cnn.com/2016/05/11/health/sanjay-gupta-prescription-addiction-doctors-must-lead/
I think it is likely that the new guidelines are in some way a reaction to the terrible toll that opioid addiction has inflicted on people from all walks of life, and the destructive effect that addiction has had on many communities. If the new guidelines avoid opioid prescription, and thus help people avoid starting on a path that would lead to addiction for them, they are very welcome additions, indeed. See: https://www.acpjournals.org/doi/10.7326/L17-0471
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