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The American College of Physicians has published an evidence-based clinical practice guideline for the noninvasive treatment of low back pain. About one quarter of U.S. adults have reported experiencing low back pain in the past 3 months.


Noting that most patients with acute or subacute low back pain improve with time regardless of treatment, the guideline recommends initial nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation. If these are ineffective, clinicians may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

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For chronic low back pain, the guideline recommends exercise and other nonpharmacologic interventions as initial therapy. If this is ineffective, clinicians may consider adding NSAIDs as the first-line drug therapy, and tramadol or duloxetine as second-line therapy. Opioids should be considered only as a last resort and only if the benefits outweigh potential risks, such as addiction and accidental overdose.


Source: Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.