New Guidelines for Back Pain

You’ve got back pain and up to 80% of Americans do or will have in their lifetime. Here’s a shocker–put on your seat belt:  Do not call the doctor.  This is advice coming from a doctor.  No, it’s not because you lost your Affordable Care Act insurance and now have to sell more blood to take care of your medical bills.  No, it’s not because the doctors aren’t pressured by Big Pharma to dole out the addict-inducing opioids, scans and injections.  It’s because doctors how have new guidelines handed down by the American College of Physicians for the treatment of back pain. This is big news, I’m pretty sure.

According to the previous guidelines, the first line of therapy was medication. This may be obvious to you.  Now, pills, even the over-the-counter pain relievers and anti-inflammatories, should not be first choice, according to the February 14 reporting in the New York Times, Lower Back Ache? Be Active and Wait It Out, New Guidelines Say and an accompanying opinion on February 17.  The new recommendation is to look for nonpharmacological therapies first.  Whaa?  No prescription pad, no trip to CVS, no side-effects, no out-of-pocket expense?  What could it be that is as effective as the almighty, chalky white, round pill?  Okay, you’re way ahead of me.  Yes, yoga.  But more, like exercise, acupuncture and massage therapy.  Did they mention yoga?  Yes, they did.

From the NYT:

“Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.”

Patient without acute back pain, that which lasts 4 weeks or less and doesn’t radiate down the leg, do not need to see the doctor.  They’re making an analogy to the common cold:  “it can be annoying when it happens, but most of the time it will not result in anything major or serious”.

The placebo effect even works wonders, even when the patients knew they were taking a placebo.  Studies have shown that patients with chronic low back pain reported less pain and disability on a placebo than those in the control group.

The article explains that some people with chronic back pain tend to shut down and avoid their usual activities.  This is the opposite of what needs to be done.  People need to return to their normal activities.  The article quotes a doctor stating, “I know your back hurts, but go run, be active, instead of taking a pill.”

Before you start cheering and thinking there was a least one speck of good news this week, it’s not all so rosy.  Patient want the quick fix.  There are incentives for doctors to push the pills, scans and injections.  Medical insurance does not pay for the remedies, like massage, tai chi, yoga, mindfulness training or chiropractic manipulation.  Doctors don’t often have a referral system for therapies outside the allopathic medical system.

Here is what I recommend if you’ve got non-chronic back pain.  Stop doing what’s causing the pain.  Much back pain is from our lifestyle, like sitting, doing stupid things or periodic tasks like weed pulling or a weekend pick-up basketball game.  After resting the area for 24 hours or so, start some gentle movement, but staying out of pain.  As time goes on, you’ll be able to move a bit more. You can add massage, acupressure or acupuncture, or other modalities you’re comfortable with.  Of course, there are reasons to see a doctor and to seek emergency medical care.  I’ve added a list in the Notes below.

If you’re interested in how yoga can help with low back pain, I have lots of information, so please feel free to ask me.


Contact your doctor if pain: Is constant or intense, especially at night or when you lie down, spreads down one or both legs, especially if the pain extends below your knee, causes weakness, numbness or tingling in one or both legs, occurs with unintended weight loss, occurs with swelling or redness on your back
Seek emergency medical care:  Call 911 or emergency medical help or have someone drive you to the emergency room if your back pain: occurs after a high-impact car crash, bad fall or sports injury, causes new bowel or bladder control problems, occurs with a fever