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New Low Back Pain Treatment Guidelines

The authors of this study worked in collaboration with the College of Physicians and the American Pain Society to develop evidence-based guidelines on low back pain, evaluating how well different therapies work. They conducted an evidence-based review of studies published between 1966 and 2006.

The guidelines pertain to both acute and chronic conditions.

The first recommendation suggests that a focused history and physical examination should be conducted to place patients in one of three categories. These categories were non-specific low back pain, back pain with radiculopathy or spinal stenosis, and back pain associated with another specific spinal cause. The history should also include assessment of psychosocial risk factors which predict risk for chronic disabling back pain.

The second recommendation suggests that imaging should not be obtained routinely in patients with non-specific low back pain.

The third recommendation suggests that diagnostic imaging should be performed when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of the history and physical examination.

The fourth recommendation suggests that MRI or CT be performed in patients only if they are portential candidates for surgery or epidural steroid injecton.

The fifth recommendation suggest that patients should be provided with information regarding thier expected course and use of self-care options, and to remain active.

The sixth recommendation suggests the use of medications with proven benefits. For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.

The seventh recommendation suggests that for patients who do not improve with self-care options, clinicians should consider spinal manipulation for acute low back pain, and for chronic low back pain, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.


R. Chou, MD et al. Annals of Internal Medicine. 2007. Vol. 147. Pp. 478-491.

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