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Home > Healthcare 101 > The latest guidelines for treating low back pain may surprise you

The latest guidelines for treating low back pain may surprise you

If you’re one of the millions of Americans who suffer from some type of low back pain, you may have noticed recent news stories about how guidelines for treating this common condition are changing pretty dramatically.

Medical experts are now recommending a much more conservative approach to caring for low back pain. They explain that for most people the pain goes away on its own and doesn’t require drugs or other more invasive treatments.

In a recent New York Times story, Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University, compares low back pain to the common cold. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious.”

This and other research confirms that walking around the block, rather than driving to the doctor’s office, might be the best approach for some types of pain.

Based on the research, here are three tips for back pain:

1. When your back hurts, don’t immediately reach for a pill

The American College of Physicians just published updated guidelines for treating low back pain that has lasted four weeks or less. While, in the past, your doctor may have written a prescription for a pain medication like Vicodin, Percocet, or Tylenol with codeine, doctors are now urged to avoid prescribing potentially addictive drugs and to recommend other types of treatment first. This may include heat, exercise, and physical therapy.

2. Healthy activity is the best medicine

While you may feel like crawling into bed when your back hurts, it can actually slow the healing process and even make things worse.

Our body needs movement and activity to stay healthy. So, for our bones and muscles, activity is typically better than sitting still when it comes to healing. In fact, clinical studies of people with back pain show that those who stayed active had a better ability to function and recover faster.1

Try to maintain your everyday routine as much as possible. Include stretching, walking, and other low-impact exercises to keep the healing process on track. Consider seeing a physical therapist who can recommend exercises that are designed to relieve your specific type of pain and keep it from coming back.

3. An MRI isn’t always a solution for pain

MRIs (and other types of imaging) are useful tools when the source of back pain is due to an underlying health cause, like a tumor or infection, or when there is an injury to the spine itself, such as a fracture.

But often, imaging doesn’t pinpoint underlying causes, and the findings may not be the actual cause of back pain. In fact, most adults have some type of harmless back abnormality that, when exposed during imaging, can lead to unnecessary procedures.2

A summary of the new guidelines

For pain that has lasted less than 12 weeks:

  • Stay active
  • Avoid prescription painkillers
  • Avoid back imaging
  • Try alternatives like heat, massage, acupuncture, and chiropractic care
  • If you need pain relief, use over-the-counter medications like NSAIDs

For pain that lasts more than 12 weeks:

  • All of the above, plus:
  • Physical therapy, consult with a rehabilitation specialist, or other non-invasive treatments
  • If you’re not responding to therapy, your doctor may consider prescription pain medicine (only if benefits outweigh the risks)

If you have back pain accompanied by any of these “red flags” in your health history or symptoms, it’s important to get medical attention.

Health history red flags

  • Recent trauma (e.g., a fall or car accident)
  • Use of medicines that weaken your immune system or make your bones thinner
  • History of cancer or osteoporosis
  • Intravenous drug use
  • If you are 70 or older

Symptom red flags

  • Unexplained weight loss or fever
  • Weakness
  • Numbness, or tingling in a specific area of the body
  • Difficulty controlling your bladder or bowel function
  • Nighttime pain
  1. Malmivaara A, Hakkinen V, Aro T, et al. Treatment of acute low back pain: bed rest, exercises, or ordinary activity? N Engl J Med 1995
  2. Jensen MC, et al, Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994
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