American College of Physicians: Use Alternative Therapies for Back Pain, Opioids Last Resort

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American College of Physicians: Use Alternative Therapies for Back Pain, Opioids Last Resort

According to guidelines released this week from the American College of Physicians, patients who suffer from chronic back should first try alternative treatments before turning to opioid painkillers. Preferrable treatments include acupuncture, medication, tai chi, and yoga.

These guidelines, published in the Annals of Internal Medicine, are just the latest among several recent professional recommendations intended to curb the country’s opioid addiction epidemic. The new recommendations are based on reviews of over 150 studies.

Last year, the surgeon general estimated that opioids are now responsible for approximately 78 overdose deaths per day. The new guidelines note that they should be an option only for patients who have not received effected results from other treatments, “and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits.”

But unfortunately, health insurance is more likely to cover prescription medication than tai chi or yoga classes. And surgery, although once a popular option, has more recently been found to garner mixed results, or even make pain worse.

Ironically, prescription opioids can also increase a patient’s level of pain. It’s a condition called hyperalgesia, and it causes the patient to become more sensitive to pain in the long run.

The guidelines, released last Monday, made three sets of recommendations:

  • For acute pain (lasting up to 12 weeks) non-medicinal treatments are preferred. The strongest evidence is for the application of heat. There is additional evidence for acupuncture, massage, and spinal manipulation. Medicinally, evidence supports the use of non-steroidal, anti-inflammatory drugs such as aspirin, ibuprofen, and muscle relaxants.
  • Chronic pain (lasting more than 12 weeks) should be treated initially with exercise, multidisciplinary rehabilitation, and acupuncture. There is also evidence for the effectiveness of other practices including biofeedback, cognitive behavioral therapy, tai chi, and yoga.
  • Chronic back pain that does not respond to non-medicinal treatments should be treated with NSAIDS first. Tramadol (an opioid) or duloxetine (an antidepressant) are recommended as a second line of treatment. Other opioids are only indicated as a last resort.

~ G. Nathalee Serrels, M.A., Psychology

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