New Guidelines for First-Line Care for Chronic Low Back Pain
Low back pain is a huge problem in the United States. Every year, billions of dollars are spent on the management and treatment of this condition. But there's not a lot of agreement among health care professionals on what this treatment should be.

The American College of Physicians (ACP) and the American Pain Society (APS) have offered some guidelines for first-line therapy. They discourage the use of diagnostic imaging and tests on a routine basis. They encourage the use of self-care. Oral analgesics such as Tylenol or nonsteroidal antiinflammatory drugs should be used first. Exercise and spinal manipulation are important nonsurgical and nondrug approaches to chronic low back pain.

This guideline is directed at patients with nonspecific low back pain. Nonspecific means there's no known cause for the problem. There's no infection, fracture, or tumor to point to as the cause. Imaging and testing procedures all appear normal with this group of patients.

But another group, the American Society of Interventional Pain Physicians (ASIPP) is concerned about these proposals. They are concerned that third party payers and insurers will refuse to pay for services when they are needed. Reducing access to necessary testing and treatment isn't going to help patients in pain.

All groups agree that selecting the right treatment is based on understanding which services are known to help select groups of patients. Treatment outcomes are improved with properly chosen patients.

More research is needed to continue identifying subgroups of back pain patients who can benefit from each individual therapy. Doctors must read the literature to know when there is evidence to support one type of therapy over another. Without proof to show a treatment is effective, it should not be applied.

Physicians can expect new guidelines every three to five years as the research is reviewed and summarized that often.
Adam Marcus. APS Guidelines for Low Back Pain Show Little Love to Interventional Therapies. In Pain Medicine News. June 2008. Vol. 6. No. 6.