- Keeping moving
- Physical therapy or manipulation therapies
- Acupuncture, tai chi (clinician should emphasize possible benefits – likely enhances the placebo effect!)
- NSAIDs – lowest effective dose for shortest period – 1st line pharmacotherapy
- Can try APAP in those with NSAID contraindications, but unlikely to help
- Duloxetine (other SNRIs may work, but evidence lacking) – 2nd line pharmacotherapy
- Tramadol and other opioids – way-down-the-line pharmacotherapy – lowest effective dose for shortest period
- Pts who use opioids are FOUR TIMES more likely to be chronically disabled by their back pain.
DOES NOT WORK:
- Recent guidelines no longer recommend tricyclics (amitriptyline, etc) or acetaminophen for back pain that lasts more than 12 weeks.
- It’s because evidence suggests tricyclics aren’t better than placebo for chronic low back pain…and there’s no proof acetaminophen works for acute or chronic low back pain.
- topical NSAIDs
- TENS devices
- topical lidocaine