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New recommendations for low back pain treatment

Created date

November 3rd, 2017
Lower back pain.

Lower back pain.

Being upright and bipedal has wonderful advantages, but as with all good things there is often a downside, and in this case, the downside is low back pain (LBP). Most people will experience an episode of LBP at least once in their lifetime. For older adults, degenerative disc disease and arthritis in the lumbar spine are practically universal conditions and cause most cases of chronic low back pain. However, LBP can be caused by a number of more significant illnesses. Thus, you should always start with a physician evaluation to rule out other conditions, including but not limited to, neurologic disease, vertebral fracture, infection, and cancer.

Research shows that compared to young adults, older adults tend to cope better with LBP without needing treatment. But when LBP significantly affects your daily functioning, it should be addressed.  

There has been a significant increase in diagnostic and treatment modalities for LBP in recent years. Medicare reports about a 300% rise in the number of magnetic resonance images and a 220% increase in spinal fusion procedures. Costs have risen to well over $30 billion annually. 

New guidelines

Patient outcomes for LBP due to arthritic changes, however, have not improved. Because of this, the American College of Physicians (ACP) conducted an extensive review of the research on LBP care and has published new guidelines about treatment. The ACP’s review found that patient outcomes were about the same with all treatments, so a safe approach is particularly desirable. 

Many options are available, including exercise, rehabilitation therapies such as physical and occupational therapy, acupuncture, and chiropractic care. In addition, several mind-body practices are recommended. Examples include tai chi, yoga, progressive relaxation, electromyography biofeedback, and cognitive behavioral therapy. Mind-body practices are a safe and often effective approach as your body can respond differently to pain if you modify your thoughts and/or reduce physical and emotional stress. 

The ACP recommends that medication should only be considered if all other treatments are ineffective. Acetaminophen (Tylenol), which used to be considered a first-line choice, has been found to be ineffective. Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce swelling to some degree without affecting mental alertness, but for older adults (age 65 and up), they come with significant risks, including but not limited to, gastrointestinal bleeding and reduced kidney function. 

A recent review showed that doctors are increasingly prescribing gabapentinoids (gabapentin and pregabalin) for LBP. The adverse effects of these drugs, however, have been shown to far outweigh the minimal pain relief they provide. The side effects are particularly dangerous for seniors: dizziness, cognitive difficulties, and fatigue—all of which increase the risk of falls. Opioids are also very dangerous because they have similar side effects, and they can also lead to tolerance and dependence. As with all medical conditions, the treatment should not be worse than the disease.

If you have LBP, start with a physician visit, rule out more significant conditions and carefully discuss all risks and benefits of treatments available. While you may not achieve a cure, proper treatment may help you cope with LBP, become more functional, and, most importantly, enjoy your life to the fullest. 

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