The vast majority of American adults will experience lower back pain at some point in their lives, and now a major organization is recommending that doctors treat it in a new way. On Monday, the American College of Physicians released updated guidelines that urge doctors to avoid medication as the first-line therapy for lower back pain—a departure from its previous guidelines.
Instead, the organization says doctors should urge patients to use alternative therapies, like yoga, heat, exercise, acupuncture, massage therapy, low-level laser therapy, cognitive behavioral therapy, or spinal manipulation under the guidance of a medical professional before they try medication. Physicians should also tell their patients that lower back pain typically improves over time, regardless of the treatment they use.
If a patient wants medication, the organization says over-the-counter pain relievers like naproxen (Aleve) and ibuprofen (Advil) could help, as can muscle relaxers, but it notes that steroid injections and acetaminophen (Tylenol) have not been found to be helpful.
Since opioids have such a high risk for addiction and accidental overdose, the ACP says they should be considered a last option for treatment. Even then, they should only be considered for patients who haven’t had success with other therapies.
Lower back pain is one of the most common reasons why people visit a doctor in the United States, the ACP says, and about 25 percent of all American adults report these aches lasting at least one day in the previous three months.
These new guidelines just “make sense,” David N. Maine, M.D., director of The Center for Interventional Pain Medicine at Mercy Medical Hospital in Baltimore, tells SELF. “Most people do get better from acute low back pain, so most treatments do not need to be pharmacologic or invasive,” he says.
Morton Tavel, M.D., a clinical professor of medicine at the Indiana University School of Medicine and author of Snake Oil Is Alive and Well: The Clash Between Myths and Reality—Reflections of a Physician, agrees. “Since most episodes of back pain resolve spontaneously, any measures employed will be credited with its ‘cure,’” he tells SELF. That’s why he says it’s so important to avoid opioids—they can be addictive and won’t speed recovery anyway.
While the ACP listed several options that people with lower back pain can try, Dr. Maine says that no particular type of therapy has found to be better than another. Acupuncture may be just as helpful for your back pain as yoga—it just depends on what you prefer. These methods may even be helpful due to a placebo effect, i.e., if you think it helps ease your pain, it can, Dr. Tavel says.
However, Santhosh Thomas, D.O., medical director of the Center for Spine Health at the Cleveland Clinic, tells SELF that yoga in particular can help with conditioning, which can improve flexibility and core strength. “These things are often lacking in people with chronic pain,” he says, adding that moving more and building strength can also help prevent future back pain.
Of course, if you’re suffering from lower back pain, you shouldn’t simply write off your symptoms and hope they’ll go away. While you could go straight to a yoga class or masseuse for therapy, Dr. Maine says your doctor may be able to provide some additional guidance.
It’s important to note that the new guidelines should be used for chronic back pain, not a sudden injury that you get from, say lifting something heavy, Dr. Thomas says, or lower back pain that radiates into other areas of your body. That’s why Dr. Maine says it’s important to see a doctor if you have any weakness, the pain is radiating into your extremities, you still have pain after two to three weeks, or the pain is quickly getting worse.