A recent recommendation from the American College of Physicians (Internal Medicine) now recommends nonpharmacologic therapies as the first line treatment of acute or subacute lower back pain lasting 12 weeks or less. This might bring more people to our Emergency Departments so it is important that we know their current recommendations.
Some nonpharmacologic therapies recommended are:
Moderate Evidence: Superficial heat
Low quality evidence: Massage, Spinal manipulation, or accupuncture
For acute back pain they recommend:
NSAIDs or muscle relaxants
Acetominophen is NOT recommended. No evidence it is beneficial
For chronic back pain:
Start with NSAIDs—>tramadol—>duloxetine.
Opioids are only recommended for treatment failures.
