Noninvasive Treatments for Low Back Pain: Clinical Guidelines by the American College of Physicians

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:

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:

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.

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 ACP Journals — 2025-11-25

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