Chronic Low Back Pain: What does and does not work (according to current evidence)

DOES WORK:

  • 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.
  • SSRIs

UNKNOWN EFFECTIVENESS

  • topical NSAIDs
  • TENS devices
  • topical lidocaine

 

 

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