## Overview
The *Annals of Internal Medicine* published the **American College of Physicians (ACP)** clinical practice guideline addressing noninvasive treatments for acute, subacute, and chronic low back pain. It summarizes evidence-based recommendations to optimize patient care while minimizing unnecessary interventions and harm.
## Key Recommendations
### Acute and Subacute Low Back Pain
For most patients with acute or subacute low back pain, the ACP recommends nonpharmacologic treatment as the first option. Suggested methods include:
- Superficial heat therapy
- Massage
- Acupuncture
- Spinal manipulation
If drug therapy becomes necessary, clinicians should consider nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.
### Chronic Low Back Pain
For chronic cases, nonpharmacologic treatments should precede medication use. Evidence supports approaches such as:
- Exercise therapy
- Multidisciplinary rehabilitation
- Mindfulness-based stress reduction
- Cognitive behavioral therapy (CBT)
- Yoga or tai chi
- Spinal manipulation
If these methods do not yield adequate results, the guideline advises using NSAIDs first and considering tramadol or duloxetine as secondary options.
### Clinical Notes
The guideline cautions against long-term opioid use for chronic low back pain due to risks of dependence and limited evidence of durable benefit.
> “Clinicians should avoid costly and potentially harmful treatments and focus on evidence-based noninvasive approaches.”
## Practical Implications
These recommendations emphasize a patient-centered approach, encouraging the use of safe, effective, and affordable therapies tailored to individual needs and pain duration.
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*Author summary: ACP advises prioritizing natural, evidence-based therapies—heat, exercise, mindfulness—over drugs or invasive treatments for low back pain management.*
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ACP Journals — 2025-11-25