HealthDay News — First-line therapy for patients with low back pain should be simple non-pharmacological remedies — from heat wraps to physical therapy, according to a new clinical practice guideline from the American College of Physicians (ACP) published in the Annals of Internal Medicine.

The recommendations are based on a review of studies of evidence for various stages of low back pain. In many cases, the ACP found, the therapies — pharmacological or not — showed small to moderate benefits.

In general, the ACP said, patients with low back pain should first try non-pharmacological options. For pain that has lasted fewer than 12 weeks, research suggests that heat wraps, massage, acupuncture, and spinal manipulation may ease pain and restore function to a moderate degree. If the pain lasts more than 12 weeks, studies suggest some non-pharmacological options can still be helpful, according to the guidelines. Those include exercise therapy; acupuncture; mind-body therapies like yoga, tai chi, mindfulness-based stress reduction, and guided relaxation techniques; and cognitive behavioral therapy.

When medication is used, the ACP advises starting with nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen — or possibly muscle relaxants. Acetaminophen is no longer recommended. Citing moderate-quality evidence, the guideline recommends opioids as an option only in patients who have failed all aforementioned treatments, and only if the potential benefits outweigh the risks.


Qaseem A, Wilt TJ, McLean RM, Forciea MA; for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guidlines from the American College of Physicians [published online February 14, 2017]. Ann Intern Med. doi:10.7326/M16-2367