Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain

What is low back pain?

Most people have low back pain at some point in their lives.

Some people with low back pain may also feel muscle weakness or a tingling sensation.

Most periods of low back pain get better in a few days or weeks without treatment. Sometimes treatment may be needed based on what is causing the pain and how long it lasts. There are 3 types of low back pain: acute, subacute, and chronic.

• Acute: low back pain that lasts less than 4 weeks

• Subacute: low back pain that lasts 4 to 12 weeks

• Chronic: low back pain that lasts more than 12 weeks

How did the American College of Physicians (ACP) develop these guidelines?

The authors looked at studies related to the use of medicines and other noninvasive methods (treatments other than surgery) for treating low back pain in adults. This information was used to develop advice for doctors and patients.

How are patients treated for low back pain?

If the pain does not go away on its own, a patient can work with his or her doctor to decide on the best treatment option. This will usually include such treatments as therapy or medicines.

Surgery is rarely needed for patients with low back pain.

What does ACP recommend that patients and doctors do?

Patients with acute or subacute low back pain usually get better over time, so they probably will not need medicines. They should discuss other treatment options with their doctors.

•Studies show that heat therapy can help ease pain.

•Studies show that the following treatment options may help, but the data are not as strong:

○Massage

○Acupuncture: a medical professional places tiny needles in the skin at certain points on the body

○Spinal manipulation: adjustment of the spine by a medical professional

•If these treatments do not work, patients and their doctors should discuss medicines, such as ibuprofen or muscle relaxants.

Before taking medicines, patients with chronic low back pain should try other treatments.

•Studies show that the following treatment options can help relieve pain:

○Exercise

○Rehabilitation: therapy that addresses physical, psychological, and social issues that may be causing pain

○Acupuncture

○Mindfulness-based stress reduction: learning ways to focus and calm the mind

•The following treatment options can also help relieve pain, but the data are not as strong:

○Yoga: exercise that includes controlled breathing, meditation, and practicing different poses

○Tai chi: a martial art that includes slow, calming movements

○Motor control exercise: a type of exercise focused on strengthening back muscles

○Progressive relaxation: a technique for tightening and relaxing muscles

○Electromyography biofeedback: a practice that includes using a special machine to sense muscle tension and help release it

○Low-level laser therapy: low-power lasers that can help heal muscles

○Operant therapy: a type of psychological treatment that rewards or punishes patients for certain behaviors

○Cognitive behavioral therapy: a type of psychological treatment that helps increase awareness of and change negative thinking

○Spinal manipulation

If these nonmedicine treatments do not work, patients with chronic low back pain and their doctors should discuss medicines, such as ibuprofen, tramadol, or duloxetine, as possible treatment.

Opioids should be considered only if no other treatments work and only if there are more benefits than risks for an individual patient.

Questions for My Doctor

How long will it take for the pain to go away?

What symptoms could mean I have a more serious condition?

How long should I be taking my medicines?

Are there activities I should avoid?

What if my pain gets worse?

How can I prevent back pain in the future?

Are there any exercises I can do to strengthen my back?

When can I go back to work?