People with back pain shouldn’t turn to medications first, according to updated clinical guidelines from the American College of Physicians.
Instead the new guidelines recommend that acute or subacute low back pain is treated with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation.
If patients do not respond to these measures, the college recommends that NSAIDs are considered as first line therapy; or tramadol or duloxetine as second line therapy.
Physicians should only consider opioids as an option in patients who have failed these treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.
Most notably, paracetamol was struck off the back pain agenda, with the guidelines acknowledging new evidence that the drug was not effective in treating lower back pain.
For a full copy of the guidelines click here.