Everyone gets back pain. It’s as paying taxes and departure as inescapable. But at least you are able to take painkillers, right? Except that the American College of Physicians (ACP) has announced that drugs should not be the first line of treatment. Codeine (with paracetamol) and also the occasional diazepam are especially frowned upon because they carry the threat of addiction.
Needless to say, times change: I remember patients with back pain consistently arriving by ambulance to be strapped to beds with traction devices.
Extreme back pain usually lasts less than four weeks if it persists for more than 12, –, then it becomes long-term. What the ACP pressures is that many people with back pain get better, irrespective of treatment. Doctors should therefore prevent any evaluations and treatments that may cause injury.
The ACP’s recommendations are derived from a thorough review of the evidence – but the research is usually lousy. Massage and acupuncture are advocated based on “ low-quality the well-being watchdog Nice takes the opposite view, stating: “Do not offer acupuncture for managing low back pain and also signs”.” Both Fine and the ACP suggest trying spinal manipulation, although it is only recommended by Nice as part of a treatment package that includes of mental therapy and exercise. Anyone with back pain can probably testify to the advantage of a hot water bottle, although the research is feeble on whether heat helps.
If nothing else works – as well as the passing of time has the most evidence going for it – the ACP proposes non steroidal anti-inflammatories such as ibuprofen. A Smartie can also attempt: research demonstrated ibuprofen was not much better than a placebo before this month. Paracetamol is also for helping back pain, no better.
Pleasant says it’s sensible to use poor opioids for pain that is acute if ibuprofen will not work or is overly dangerous. For sciatica, in which a nerve root is compressed in the back, there’s little evidence that any interventions help a whole lot.
Fine stresses the importance of exercise, psychological treatments and for individuals to continue with normal activities. Anyone with chronic back pain will understand there’s no magic bullet. These latest recommendations give attention to not making things worse. More details can be found at back pain discussion forum.