7 Guidelines for Treating Low Back Pain - Does Your Doctor Know Them?
The American College of Physicians recently released its guidelines for diagnosing and treating lower back pain. These guidelines are the result of a long and intensive review of research on lower back pain. I have translated them from “doctorese” for you benefit.
1. Treating professionals should take a good history and do a thorough physical exam. The purpose of that exam is to identify which of three categories of back pain you have. The three groups are back pain with no specific cause, back pain with radiculopathy or spinal stenosis, or back pain with some other specific cause.
2. If you are in the first (non-specific) group, your doctor should not order routine imaging tests like x- rays or MRI’s.
3. If your back pain is accompanied by worsening neurological deficits or evidence of some serious underlying medical condition, then the doctor should order diagnostic and imaging tests.
4. If you have lower back pain and radiculopathy, then MRI’s or CT scans should be ordered only if you are a candidate for and epidural injection or surgery.
5. Your doctor should give you evidence-based information on low back pain. This information should include the expected course of their pain, advice to remain active, and a review of possible self-care alternatives.
6. Your doctor should consider medications that have been shown to be effective, and should use them along with self-care options. Medication should be accompanied by an assessment of your pain levels, and you should be advised of all the pros and cons of the medications. Recommended started medications for most people are an NSAID or acetaminophen.
7. If improvement is not seen with this program, your doctor should consider recommending other pain management alternatives. For chronic back pain, this include relaxation, acupuncture, yoga, massage therapy, exercise, and spinal manipulation.
It’s to your advantage to be an informed patient and know these guidelines. They tell you what information your doctor should be getting from you, and what issues should be addressed directly with you as you and your doctor develop your treatment plan.
These guidelines are a summary of those approved by the American Pain Society. They were released in October 2007, and have been published a number of places, including the Annals of Internal Medicine. Consider printing a copy of this article and keeping it for reference, and to discuss with your doctor if you have any questions.
Barry Hughes, Ph.D. is a psychologist and publisher of Chronic Pain Alternatives, which provides “Resources and Information for People with Chronic Pain.” He has built this site using Site Build It!, the easiest way to translate your passion onto the Web.
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