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Guidelines Summarize Approach to Managing Low Back Pain

American College of Physicians, American Pain Society offer seven recommendations

WEDNESDAY, Oct. 17 (HealthDay News) -- Aiming to address a lack of consensus on the evaluation and treatment of low back pain, the American College of Physicians and the American Pain Society issued a practice guideline, containing seven recommendations, in the Oct. 2 issue of the Annals of Internal Medicine.

Roger Chou, M.D., of the Oregon Health & Science University in Portland, and colleagues offer strong recommendations for six of these items. They begin by recommending that clinicians classify patients with low back pain into three categories: non-specific low back pain; back pain possibly associated with radiculopathy or stenosis; or pain possibly associated with other specific spinal causes.

Items related to imaging include a recommendation against routine imaging or diagnostic tests in patients with non-specific back pain; recommendation for diagnostic imaging and testing for low back pain accompanied by severe or progressive neurological deficits, or when the clinician suspects a serious underlying condition; and recommendation that clinicians order MRI or computed tomography only in cases of suspected radiculopathy or stenosis if the patient is a potential candidate for surgery, or epidural steroid injection in cases of possible radiculopathy.

"For most patients, first-line medication options are acetaminophen or non-steroidal anti-inflammatory drugs", the authors write. Finally, the report offered a weaker recommendation for adjunctive steps such as spinal manipulation for acute pain, and exercise therapy, yoga, massage, acupuncture, cognitive-behavioral therapy or progressive relaxation for chronic or subacute pain.

Honoraria was given to Chou from Bayer Healthcare Pharmaceuticals and another researcher received grants from several pharmaceutical companies.

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