Recently, acupuncture, an
important part of traditional Chinese medicine, has been recommended as one of
the favourable nonpharmacologic therapies for low back pain by American College
of Physicians. Two reports published on journal of Ann Intern Med in February
2017 by Chou et al., 2017, and Qaseem et al., 2017 made the recommendation.
Lower back pain is one
of the most common reasons for clinic visits in the United States. It is
associated with increased healthcare costs as well as lost wages and decreased
work productivity. Acute back pain generally lasts less than 4 weeks and usually
resolves on its own. Subacute low back pain is defined as lasting 4 to 12
weeks, while chronic back pain lasts over 12 weeks. Up to 30% of patients
report persistent low back pain up to 1 year after experiencing an acute
episode. One in five report substantial limitations in activity, according to
background information in the articles.
To develop the
guideline, the ACP reviewed randomized controlled trials and systematic reviews
of studies evaluating noninvasive, nondrug, and drug therapy for low back pain
in adults. To be included, studies had to be published in English between
January 2008 and November 2016. The authors identified earlier studies using
the 2007 ACP/American Pain Society systematic reviews. The agency evaluated
outcomes including reduction or elimination of back pain and number of back
pain episodes, improvement in back-specific function, improvement in health-related
quality of life, reduction in work disability, patient satisfaction, and
adverse events. The guidelines and evidence reviews also underwent peer review
and a public comment period.
Overall, the new
guidelines emphasize conservative treatment. First-line therapy should
incorporate nondrug therapies. New evidence supports acupuncture in acute low
back pain alongside with massage, or spinal manipulation; and tai chi and
acupuncture in chronic low back pain alongside exercise, multidisciplinary
rehabilitation, yoga, motor control exercise, progressive relaxation. Nonsteroidal
anti-inflammatories (NSAIDs) or muscle relaxants should be considered when
nondrug therapy fails. The guidelines strongly discourage the use of opioids (which
can be associated with addiction and accidental overdose).
Reference
Chou R, Deyo R, Friedly
J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing
S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review
for an American College of Physicians Clinical Practice Guideline. Ann Intern
Med. 2017 Apr 4;166 (7):493-505. https://www.ncbi.nlm.nih.gov/pubmed/28192793
Qaseem A, Wilt TJ,
McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of
Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back
Pain: A Clinical Practice Guideline from the American College of Physicians. Ann
Intern Med. 2017 Apr 4;166 (7):514-530. http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
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