By Dr. Dave Hnida

(CBS4) – Oh, my aching back!

New guidelines from the American College of Physicians are a huge change to the decades-old standards of the “right way” to take care of an injured back.

In essence, the guidelines recommend that you just say no to drugs if you strain, sprain, or just rack up your back. Meaning, the guidelines suggest that your aching back will likely simply get better on its own and that medications will do a little if anything to speed the process and help you get more comfortable.

(credit: CBS)

(credit: CBS)

The guidelines address back pain that is new, old, or somewhere in between. In essence, the belief is that we have been over-treating back pain and that the best treatment is, frankly, letting nature take its course and allowing the back heal on its own.  That means no muscle relaxants, anti-inflammatories, or pain medication. Wow, sounds harsh!

That’s not to say that some therapies might help ease your pain. For example, if you have uncomplicated muscular back pain, say from lifting something too heavy, you might benefit from heat, massage, acupuncture, and spinal adjustments or manipulation. Medication, including over-the-counter, is not recommended.  (I am a big fan of physical therapy, by the way.)

For back pain lasting greater than one month, therapies such as tai chi, meditation, yoga, and increased activity may be helpful. So is stress reduction.

And for pain lasting greater than 12 weeks, well perhaps medication might be useful. But not the typical medication you might think. The guidelines do not recommend the use of narcotic pain medication, muscle relaxants, but instead other medications such as tramadol, or duloxetine, also known as Cymbalta, to give the relief. These are medications that work to calm down the nerves in the muscles of the body.

Once again it’s important to emphasize that these recommendations are for uncomplicated back pain, meaning that you don’t have any numbness, tingling, or weakness going down into your legs. These are intended for simple uncomplicated back sprains.

There also is an emphasis on the importance to keep moving with a back injury. Certainly in the days after an injury it sometimes difficult to move around, however we typically recommend avoiding bed rest, as we know that lying perfectly still will only help your back stiffen up more and more.

As time goes on, the more helpful activity seems to be providing it is the right type of activity. For example, we know that certain aerobic activities, even walking, are usually very back friendly since they increase oxygen flow to the spinal region.  That, plus making sure that you stay flexible and have a strong core, can go a long way in making a back happy.

Now if you ever had back pain you may think that recommendations like this are rather heartless. But the intent is really to recognize most cases of back pain for what it is. Meaning, a stubborn yet heal-able problem that will improve if you just get out of its way.

I think that the guidelines are really saying that we tend to over treat back pain, and because we do so, we wind up causing more harm than good.

The recommendations were not simply invented in some smoke-filled back room. They’re actually based on a look at more than 184 studies that were done over the past 8 years; all of which looked at what worked and what did not when it came to back pain.

Certainly, if you nail your back pretty good, it is a good idea to be in touch with a doctor and that a check over may be a good idea. On the other hand, don’t be expecting an MRI on that first visit and don’t be disappointed if you are advised to try some “more natural” techniques rather than medication to get relief.

Obviously if we think that there is something wrong with a disc or a potential bony injury, we should jump on that and make sure that you don’t need more aggressive care.

Every case, every person, every back is different — so one size doesn’t fit all.

But the bottom line of these new guidelines is that time may the best medicine for most angry backs.

(We’ll see what you think the next time you lift that 900 pound box!)

Here is a synopsis of the new guidelines:

Dr. Dave Hnida is CBS4’s Medical Editor. He blogs about the latest studies and trends in the health world. Read his latest blog entries, check out his bio or follow him on Twitter @drdavehnida


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