Disclaimer: As with all things FMR-related, this is an introduction to a topic. It would be inappropriate to try to treat someone’s medical issues via written articles or podcasts. This is our first introduction to the treatment of a medical issue, making it important to state the disclaimer that this is informational only and not medical advice. We are posting this to help you feel knowledgeable about what is considered the best medical practice for this given topic. If you or a loved one ever deals with this issue, hopefully, this will help you better know what to expect when you seek care and treatment. With this now out of the way, on with the post.
Introduction
This is a beginner’s guide to low back pain (LBP). This information comes from a single source, The American College of Physicians (ACP). The information from the ACP is a “Clinical Practice Guideline,” which summarizes research and evidence on a given topic. As medical professionals, we use publications, like this, to help us make the best decisions possible when treating or educating someone with a specific condition.
We classify the LBP of adults into one of three groups according to how long symptoms have occurred:
Less than 4 weeks (acute)
Between 4 and 12 weeks (sub-acute)
More than 12 weeks (chronic)
In this week’s post, we will focus on the acute and sub-acute symptoms. We will discuss recommendations for chronic symptoms at another time.
Acute Symptoms
The important thing to know with acute LBP is that most people have massive improvements in pain and function in the first four weeks.. Research has shown that almost everyone who has low back pain will be back to normal after about five months. This five-month recovery is independent of treatment or medicine. In other words, our body manages to take care of the LBP on its own. While it is too bad that it takes five months to recover, it’s good to know that no matter how you feel now, odds are good you’re going to recover in a few months. It might sound crazy but that’s what thousands of research studies have taught us.
In my opinion, this brings attention to the importance of addressing movement patterns and issues of strength and flexibility. These deficits are important to look at because they may contribute to why you got LBP in the first place. Developing a successful routine for the management of contributing factors to LBP might help prevent it from coming back down the road. A well-balanced routine could help prevent other issues from arising from imbalances due to the injured low back.
These are interesting items to discuss in the future, but for now, the following are treatments that have been shown to be effective for low back pain when it occurs.
Treatment
The treatments available to adults with LBP are classified into two groups: pharmacological and nonpharmacological.
Pharmacological
This includes everything from injections to over-the-counter and prescription medicines. The following medications are only those that have been researched enough to make a judgment on.
Acetaminophen
NSAIDs
Skeletal Muscle Relaxers (SMRs)
Corticosteroids (usually as an injection or maybe prednisone)
Other medications you commonly see used for low back pain are for chronic LBP, not acute LBP.
Recommendations are classified according to the amount of and the quality of research done. Many of these are somewhat obvious, but let’s still review quickly how research quality is determined.
Poor-quality evidence is when very few high-quality research articles were included in the analysis.
Moderate-quality evidence is when only some high-quality research articles are included.
High-quality is when a lot of the analysis is on high-quality research articles.
1. There is poor evidence to shows that Acetaminophen doesn’t help for pain or function.
2. For NSAIDs, there is moderate evidence that taking these helps with pain, but not your function.
3. For SMRs, there is only poor-quality evidence that these might help short-term pain.
4. For corticosteroids, there is poor-quality evidence that these don’t help with pain or function.
In total, it seems that NSAIDs and SMRs are the only two medications that have been shown to help with acute low back pain. This doesn’t mean that the other treatments are “for sure” ineffective but there hasn’t yet been enough evidence to say that it’s effective.
Now onto nonpharmacological treatments.
Remember this is only in regards to acute low back pain.
Exercise has poor evidence to support that it doesn’t help for pain or function
For acupuncture, there is poor evidence that it makes a small improvement on pain. However, it may be better than NSAIDs.
For massage, there is poor evidence that it helps short-term pain and function for sub-acute LBP. There’s almost moderate-quality support for its use in the short-term versus other interventions. Poor evidence supports that it’s better in combination with other treatments (like exercise or spinal manipulation) instead of those other treatments alone.
For spinal manipulation, there is poor evidence that its use alone or with other treatments is at best helpful in the short-term.
For superficial heat, there is a consistent benefit for symptoms and function for acute LBP. The amount of evidence is mostly poor that supports the benefit of heat versus other treatments.
Low-level laser is supported by poor evidence that, when included with NSAIDs, has a pretty good effect on pain and a moderate effect on function.
Lumbar support, lastly, seems to not make a difference on symptoms or function. However, this is also supported by poor-quality evidence.
The most important thing about these recommendations is that they are just that. Recommendations. If you ever have to deal with low back pain, you need to agree to and be comfortable with the treatment. I hope this all made sense. Remember that we’ll be discussing this and more on the podcast.
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1. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
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