A review of studies involving the diagnosis and treatment of non-specific low back pain indicated that most patients do not require immediate diagnostic imaging or referrals to a back-pain specialist to properly treat their symptoms, which may be managed effectively through their primary care physician. The studies also suggest that non-pharmacologic treatments, including exercise, cognitive behavioral therapy, massage, stress reduction methods, operant therapy, spinal manipulation, acupuncture, or physical rehabilitation programs can provide some benefit to patients without an underlying spinal pathology who suffer from persistent lower back pain. Other types of intervention, though, including the use of opioids or NSAIDS, may offer temporary pain relief but few long-term palliative benefits and can be harmful over time. Careful risk-vs-benefit evaluation should be considered prior to prescribing these and other treatments (including spinal injections) for acute or persistent non-specific low-back pain patients. The researchers emphasized that providing information, reassurance, and counseling about low-back pain was beneficial to all patients and helped reduce pain-related anxiety.
Purpose of Study
Low-back pain is ubiquitous and a leading cause worldwide of missed work, early retirement, and poverty. The associated costs of medical treatment and diagnosis are astronomical (upwards of $87.6 billion in the U.S. alone), yet statistically-speaking patient outcomes have remained stagnant—patients are not responding better to the wide array of available diagnostic and treatment options.
Shift in Protocol & New Recommendations
New guidelines of low-back pain care recommend a shift in thought for primary care physicians in response to the diagnosis and treatment of neurogenic claudication, radicular pain, and non-specific LBP patient—focusing on patient education, less invasive evaluative methods, non-pharmaceutical treatments, exercise, behavioral cognitive and other therapies, and general good health lifestyle choices and practices. Patients should be offered information on the nature of low-back pain.
The authors of the review posit that tests designed to identify the source of LBP are generally not useful and have a low level of accuracy when it comes to making a firm diagnosis. Further, drug regimen used to treat neuropathic pain are frequently ineffective and can have harmful side-effects. The same is true of structure-based treatments, such as stem cells, corticosteroids, sclerosing agents, and anesthetic injections, all of which offer little in the way of long-term LBP relief.
Imaging is indicated only when a quick diagnosis is critical, such as when the physician suspects a bone fracture or cancer. Even when ‘red flags’ are present, the authors suggest, they may be indicative of a variety of physical conditions and are therefore too plentiful to be of use in determining whether or not imaging is called for in an acute LBP patient.
Patients suffering from non-specific LBP would benefit more from non-drug treatments that emphasize education, awareness, exercise, massage, superficial heat, acupuncture, behavioral and cognitive therapies or other non-pharmaceutical strategies. Though NSAIDs and muscle relaxants can relieve acute LBP for limited amounts of time, the potential harms of taking the drugs may outweigh the short-term benefits, so extreme caution and careful evaluation should be used in prescribing these medications to LBP patients. NSAIDS and muscle relaxants can relieve LBP, The use of opioids to treat acute LBP should be discouraged and, like spinal fusion, be reserved for only the most stubborn and debilitating cases of persistent LBP.
A review of protocols in diagnosing and treating non-specific lower back pain suggests that diagnostic imaging and specialized care is rarely necessary and that most patients would benefit from patient education about lower back pain, exercise, and other non-pharmaceutical interventions. Primary care physicians should treat non-specific LBP conservatively, by offering their patients information on the nature of lower back pain and encouraging exercise and healthy lifestyle habits. Massage, acupuncture, and other non-invasive treatments are preferable to surgery or epidural procedures, which provide little long-term pain relief and carry health risks. Opioid medications should be avoided in the treatment of acute and persistent non-specific lower back pain, due to their long-term inefficiency and abundant risks.