Lancet Reconfirms Meds and Surgery Are the Last Resort for Lower Back Pain

A new report published in The Lancet indicates that many patients presenting to multiple practice settings with lower back pain (LBP) receive less than optimal care, as evidenced by the fact that their symptoms often linger for up to a year. Perhaps worse, some are still prescribed opiates despite multiple studies showing they’re not the best choice for LBP, and they leave patients at increased risk for addiction. Pooling guidelines from the U.S., United Kingdom, and Denmark, the Lancet article notes that first-line treatment for acute back pain includes educating patients on prevention of recurrence and recommendations to stay active; second-line treatments include spinal manipulation, massage, and acupuncture; and third-line treatment is nonsteroidal anti-inflammatory drugs. For chronic LBP (>12 weeks), staying active, patient education, exercise therapy, and cognitive behavioral therapy are recommended first-line; spinal manipulation, massage, acupuncture, yoga, mindfulness-based stress reduction, and interdisciplinary rehabilitation are second-line; and NSAIDs and selective norepinephrine reuptake inhibitors are third-line. Reading between the lines, that means there’s no place for opiates in treating LBP. The fact that prescribing them is a high-risk endeavor is illustrated by the fact that 76.9% of patients who are prescribed opioids for chronic LBP are still taking them more than a year later. This month’s issue of JUCM includes an original article on treating acute exacerbations of chronic LBP in the urgent care center; you can read it here.