Back pain is one of Americans’ leading debilitating complaints, prompting us to spend billions of dollars annually for relief and costing more than $100 billion, especially in lost work and wages. But an influential physicians’ group, joining a growing number of other experts, now recommends that we buck up, exercise, keep moving—and stay away from a reflexive reach for drugs, especially powerful painkillers, to deal with aching backs.
The American College of Physicians, with guidelines published in the Annals of Internal Medicine, concedes it is breaking with longstanding medical views on treating low back pain. But the group’s experts said they conducted a “systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain.”
They found that many patients with low back pain recovered over time “regardless of treatment,” and these individuals might benefit most from heat, rest, exercise, and over the counter, non-steroidal medications. Another group of back pain sufferers might need physical therapy, stress reduction, acupuncture, yoga, or ta-chi. Only after patients have not found relief with “non-pharmacological therapy,” should doctors consider giving non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these don’t work, tramadol (Cymbalta) or duloxetine (Ultram) might be considered.
Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, Ore., and an author of the new guidelines, told the New York Times that, “For acute back pain, the analogy is 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.”
But if doctors take a more aggressive course, they can create issues. Patients may want diagnostic tests, including MRI or CT scans, though these “routine” procedures, like all medical interventions, pose risks, including radiation exposure. Though doctors know these scans are unneeded, costly, and often ineffective, they may order them defensively, especially to keep a patient, research finds.
The New York Times noted that all drugs, including something as seemingly innocuous as aspirin, can be harmful to some patients, and the physicians’ group guidelines appear even as the nation battles an epidemic of opioid painkiller abuse.
Back pain can be excruciating, and some doctors may relent and prescribe powerful painkillers, despite their risks. New research indicates that some emergency room physicians are more inclined even than their ER peers to order opioids for their patients, perhaps out of reflex or habit, and, other doctors tend to follow up colleagues’ initial recommendation by further prescribing these painkillers. This can be a bad path for patients to get unneeded drugs, and for the meds to become addictive and destructive.
Meantime, physician preference also plays a key role, other research shows, as to whether patients undergo back surgery, which shows only modest effect on back pain. It is more popular in pockets of the country. After eliminating various potential driving factors, researchers fault this geographic disparity on doctor choice about the intensity of their care-giving response. To reduce “wasteful” costs that back surgery adds to health care, insurers may need to audit procedures, or systems may want to set up high-quality, high-performing centers to handle specialized cases.
I’ve seen in my practice the harms that can result from negligent medical care, including for back, brain, and spinal injuries. I’ve written about caring for an aching back, including with the push toward pain-controlling, gentler rehabilitation, without excessive reliance on drugs or invasive procedures. This condition is no fun, and I hope we keep making strides to avoid harming patients or wasting their money.