New guidelines have been put forward outlining the appropriate medical guidelines for the treatment of nonradicular low back pain. The guidelines developed American College of Physicians, following a review of research in the field, recommend a course of treatment that begins with non-drug therapies including rehabilitation and yoga. Anti-inflammatory drugs or skeletal muscle reactants are the preferred drug courses for patients who require additional treatment. Consistent with concerns about addiction and accidental overdose, opioids should be the last resort for the treatment of lower back pain.
- Non-drug therapies: heat, massage, and accupunture, progressive relaxation, electromyography biofeedback.
- These therapies have shown to be evidence based and non-invasive for acute and subacute low back pain.
- If drugs therapy is needed due to non-responsive to therapies it is recommend first NSAID’s, second tramadol, duloxetine
“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”