Exercise yes, pills no: doctors unveil guidance for lower back pain

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The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and alternative non-drug approaches. (file photo)

If you have lower back pain, the last thing you should do is take prescription narcotics.

That’s the message issued Tuesday by the American College of Physicians.

The new guideline, published in Annals of Internal Medicine, says doctors should encourage patients with lower back pain to try exercise and alternative non-drug approaches, including heat, massage, acupuncture, spinal manipulation, yoga, tai chi and mindfulness-based stress reduction, according to a release.

If those treatments don’t provide relief, patients should try pain relievers such as NSAIDs, followed by drugs such as tramadol or duloxetine. Only as a last resort, when the potential benefits are greater than the harms, should doctors prescribe opioids, according to the guidance.

A physical therapist in the Historic Triangle applauded the ACP’s focus on staying active when injured.

“Movement and exercise is key to helping facilitate healing,” said Andy Foster, a physical therapist at Sentara’s Williamsburg Therapy Center, 301 Sentara Circle.

The ACP’s recommendations come at the intersection of two public health trends: a crisis in opiate addiction and widespread complaints about lower back pain. About 25 percent of American adults report having experienced lower back pain at least once in the previous three months, according to the release.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” Dr. Nitin S. Damle, president of the ACP, said in the release. “Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose.”

Foster, a physical therapist for more than five years, frequently sees patients with lower back pain. For them, a physical therapy diagnosis could range from gait abnormality to muscle weakness to soft tissue injury, such as a pulled muscle.

“It’s gonna be patient-dependent,” he said.

Treatment options include exercise, strengthening, stretching, ultrasound and mechanical traction, according to Foster. He also recommends home-exercise programs, to help facilitate healing.

“We definitely want to educate the patient,” he said.

That’s a sentiment echoed by Bill Hansell, who teaches tai chi in the Historic Triangle, including classes offered by Williamsburg Parks and Recreation. Hansell, a Vietnam veteran, describes tai chi as a series of movements, coordinated with weight shifts and arm and hand positions, that make energy flow through the body to maintain health. 

If he hears someone complains about lower back pain, he looks at their posture. 

“That’s the primary thing that I find incorrect, especially with older students,” he said.

Once the torso is in the right position, he added, people tend to experience some relief. Weight distribution is also important, since bad balance and lower back pain go together.

“There could be dozens and dozens of reasons why people have lower back pain,” he said. “Bad posture is just one.”

For more information about tai chi, go here or email hanselltaiji@gmail.com.

The ACP issued recommendations for treating lower back pain in 2007. That guidance did not evaluate treatments such as tai chi or stress reduction based on mindfulness practices.

Before trying any new health regimen, you should check with your doctor.