New Guidelines for Back Pain: Seek Alternative Therapies Before Drugs – (blog)

Woman stretching on dockNew guidelines from the American College of Physicians urge medical professionals to avoid medication as a primary treatment for low back pain. Instead, the guidelines point to alternative therapies such as massage, acupuncture, superficial heat, mindfulness, yoga, and spinal manipulation.

Many doctors prescribe opioids for people with chronic pain, but the new guidelines say opioids should only be recommended as a last resort after more natural pain-relieving methods have been exhausted.

Opioids are a main source of the increasing rates of drug addiction and overdose deaths. In 2014, prescription opioids killed nearly 29,000 people. The Centers for Disease Control and Prevention (CDC), which has called opioid abuse an epidemic, recommended in 2016 that doctors prescribe opioids only when other remedies fail.

Non-Drug Remedies as First Option for Back Pain

The report addresses two types of pain. Acute pain is short-lived, usually appears suddenly, and is often the result of an injury. Chronic pain lasts longer, has many physical and psychological causes, and can be more difficult to treat.

Experts now recommend nonpharmacologic treatments for acute back pain. The report points out most acute pain resolves on its own with or without treatment. If other remedies fail and a person wishes to try medication, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and muscle relaxants are better alternatives to opioids.

Research suggests acetaminophen might not relieve back pain. A 2015 review of 13 studies found acetaminophen, which is branded as Tylenol, is ineffective at alleviating low back pain as well as hip and knee osteoarthritis. At high doses, acetaminophen can damage the liver, raising further concerns about its use as a first-line treatment for pain.

Effective Treatment for Chronic Low Back Pain

According to the new guidelines, people who experience chronic low back pain should pursue non-drug remedies such as exercise, rehabilitation, mindfulness, acupuncture, yoga, relaxation, laser therapy, or psychotherapy. If these remedies do not effectively relieve pain, physicians should not immediately resort to opioids. Instead, the guidelines recommend NSAIDs as a first-line treatment, or selective norepinephrine reuptake inhibitors (SNRIs), such as duloxetine, as second-line treatments.

The guidelines do not recommend opioids such as tramadol until all other treatments fail, and physicians should not prescribe them unless they determine the benefits outweigh the risks for an individual patient.


  1. Preidt, R. (2015, April 1). Popular painkiller doesn’t help low back pain, arthritis, study finds. Retrieved from
  2. Qaseem, A., Wilt, T. J., Mclean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. doi:10.7326/m16-2367

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