New guidelines say pain meds not needed for back pain

Lower back pain is one of the most common complaints for Americans today. About a quarter of all U.S. adults have reported lower back pain lasting at least one day in the past three months, according to statistics published by PubMed.

In 2006, costs associated with those seeking treatment for lower back pain were estimated at $100 billion. These costs include missed work and low productivity. However, many people suffering with lower back pain are concerned about starting a pain medication, especially with the rise of opioid addiction. There is some good news - new recommendations have found that treatment of lower back pain can be successful with alternative therapies and without opioids.

New guidelines released by the American College of Physicians state that treatment of back pain no longer needs to include pain medications. These guidelines specifically point to the treatment of back pain with nonsurgical options. A study compared results from noninvasive treatments with use of pain medications against results from noninvasive treatments without pain medications. The study found that patients did not need pain medications in all cases in order to have relief from back pain.

There are several ways physicians were able to reduce back pain without drugs:

For severe lower back pain, patients found relief with superficial heat such as that used in massage, acupuncture or spinal manipulation. In some cases, physicians may also recommend a pain medication to accompany these types of treatment, but the study stresses the use of anti-inflammatory drugs that do not contain a steroid.
For patients with chronic lower back pain, physicians are recommended to initially utilize treatment with exercise, either through a rehabilitation program such as Beebe HealthyBack or utilizing acupuncture, mindfulness-based stress reduction, tai chi, yoga, relaxation therapy, biofeedback, or spinal manipulation, among other techniques.
In cases when patients are not responding to non-medication techniques, the American College of Physicians recommends anti-inflammatory drugs that do not contain a steroid. The ACP cautions that physicians should only consider an opioid in patients who have attempted all other treatment options and are still not improving.
Programs such as Beebe HealthyBack have shown that targeted exercises, yoga and stress reduction can improve lower back pain.

Over the last 25 years, the University of Florida, the University of California at San Diego and medical institutions around the world have published compelling research showing that specific spinal strengthening using the FDA-registered PHB Lumbar and Cervical Extension machines improve patient outcomes even after multiple failed attempts at other forms of treatment.

The machines used at Beebe HealthyBack allow patients to strengthen muscles, improve disk health, and increase endurance, mobility and function over the duration of their treatment. Beebe's care professionals teach patients how to continue strength and flexibility exercises at home, and the team provides ongoing support and motivation for patients.

There are some cases where opioid use is still the recommendation, including for those people who suffer from spinal stenosis (pinched nerves) in the neck and back. For these patients, it is important that opiates are used for a short term (about one month) to control pain. They are also recommended in some cases to control pain post-operatively.

In cases where pain is not relieved with continued conservative care, there are surgical options available that have been proven to have high success rates at reducing and eliminating pain.

For more information about Beebe HealthyBack, a nonsurgical approach to back or neck pain, call 302-856-9729 or go to www.beebehealthcare.org/healthyback.

Ronald Sabbagh, MD, is a board-certified orthopaedic spine surgeon and Beebe's chief of surgery 2011-16. He received his medical degree from Georgetown University and completed his residency in orthopaedic surgery at Union Memorial and Johns Hopkins hospitals in Baltimore. He is fellowship trained in spinal reconstructive surgery. For more information on orthopaedic services at Beebe Healthcare, go to www.beebehealthcare.org/patient-care-services/orthopaedic-services-beebe.