Back Pain Treatment

Something really important happened in October 2007 – a Clinical Guideline for back pain treatment in America was published (1).

So what, I hear you say?

Well, a Clinical Guideline is a document drawn up by experts who have looked thoroughly at all the best research evidence for treatment and made a decision about suggesting the best type of treatment. Guidelines are very helpful as they evaluate all the latest research and offer guidance on best care.

In Europe we have had clinical guidelines to help us with back pain treatment for years; the latest is the Prodigy Guidance (2). But there has been no decent equivalent USA guideline. This new USA guideline has been drawn up as a clinical practice guide and has been endorsed by the American Pain Society and the American College of Physicians – serious credentials.

It is interesting that in the USA surgery rates for low back pain are much higher than in the UK. Despite there being a great deal of evidence that suggests keeping active and avoiding some passive therapies is the best way forward, many people still get inappropriate treatment.

This latest guideline will hopefully help make sure that if you have back pain you get consistent care and the best advice.

What is the advice?

It’s very similar to the European Guidelines and according to this there is good evidence that the following offer moderately effective back pain treatment for chronic or sub-acute pain:

Cognitive Behavioural therapy (this is linked to yellow flags – read about them to understand more)
Exercise
Spinal manipulation

There is fair evidence that the following are helpful for chronic pain:

Acupuncture
Massage
Yoga
Functional restoration

For acute pain the only recommendation is for:

Heat therapy (Moderate benefits)
Manipulation (Small benefits)

There is no evidence to show that the following are effective:

Back Schools
Interferential therapy
Cold laser therapy
Lumbar supports (corsets)
TENS
Traction
Ultrasound

Ask your health care provider if they have read these guidelines.

References

1.Chou, R. & Huffman, L. H. 2007, "Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline", Annals of Internal Medicine, vol. 147, no. 7, pp. 492-504.

(2)Prodigy Guidelines

05-Sep-2008