Low Back Pain Treatment Options for Primary Care

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Eighty percent of adults experience low back pain at some point.
Eighty percent of adults experience low back pain at some point.

Considering 80% of adults experience low back pain at some point, and 20% go on to develop chronic pain, managing low back pain is a big part of any primary care practice. 1 “After you rule out systemic, neurologic, and surgical patients, you are still going to be left with many patients who have chronic low back pain,” said Richard A. Deyo, MD, professor of family medicine at Oregon Health & Science University in Portland, Oregon.

Clinical guidelines for low back pain from the American College of Physicians (ACP) recommend self-care for patients with persistent, mild low back pain and no functional impairment.2 “A good way to evaluate these patients is to ask if they can find a position of comfort. If they can, exercise is usually the best treatment. Exercise uses muscles to unload the back pain,” said Eric Mayer, MD, at the Cleveland Clinic's Center for Spine Health.

Self-Care

ACP self-care recommendations also include staying active, educating the patient about the condition, and using superficial heat. “Exercise can be done as part of physical therapy at the outset. Supervision and instruction is a good beginning. After that, patients do best with any exercise they enjoy and will stick with. It could be tai chi, yoga, swimming, or biking,” said Deyo.

“An important part of education is teaching the patient about the profound link between smoking and back pain. Educations also includes the importance of weight loss and learning exercises that promote core strength and flexibility, like yoga, swimming, or tai chi,” said James McGowan, MD, anesthesiologist and pain medicine specialist at Mercy Medical Center in Baltimore.

“For patients who have mainly myofascial pain, as opposed to disc degeneration pain, heat or ice may be the best part of self-care. These patients quickly learn that heat or ice works for them, and it is [a] good clue for the doctor that the pain is mainly muscular,” said Mayer.

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