This is the 2017 ACP clinical practice guideline on noninvasive treatment of low back pain. It asks which pharmacologic and nonpharmacologic therapies actually improve pain and function in adults with acute, subacute, and chronic low back pain. Recommendations are graded from a systematic review of RCTs and prior systematic reviews.
When a patient presents with new low back pain, lead with reassurance and self-care, not a prescription pad. Most acute episodes improve on their own, so superficial heat, staying active, and NSAIDs or a muscle relaxant are enough.
The biggest board-testable shift is acetaminophen. The 2017 guideline reversed the 2007 position and found it no better than placebo for acute low back pain, so it should not be your go-to analgesic here.
For chronic pain, exercise and multidisciplinary rehabilitation come before drugs because they carry fewer harms. When you do reach for medication, follow the ladder: NSAIDs first, then tramadol or duloxetine, and opioids only after everything else fails. Remember what to avoid: systemic steroids for acute pain (even with sciatica), and TCAs or SSRIs for chronic pain. None showed benefit.
This is the 2017 ACP clinical practice guideline on noninvasive treatment of low back pain. It asks which pharmacologic and nonpharmacologic therapies actually improve pain and function in adults with acute, subacute, and chronic low back pain. Recommendations are graded from a systematic review of RCTs and prior systematic reviews.
When a patient presents with new low back pain, lead with reassurance and self-care, not a prescription pad. Most acute episodes improve on their own, so superficial heat, staying active, and NSAIDs or a muscle relaxant are enough.
The biggest board-testable shift is acetaminophen. The 2017 guideline reversed the 2007 position and found it no better than placebo for acute low back pain, so it should not be your go-to analgesic here.
For chronic pain, exercise and multidisciplinary rehabilitation come before drugs because they carry fewer harms. When you do reach for medication, follow the ladder: NSAIDs first, then tramadol or duloxetine, and opioids only after everything else fails. Remember what to avoid: systemic steroids for acute pain (even with sciatica), and TCAs or SSRIs for chronic pain. None showed benefit.