From the Guidelines
Self-management of low back pain should prioritize individualized educational interventions, application of heat, and the use of medications like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line options. When managing low back pain, it is essential to consider the severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1. For patients with acute low back pain, applying heat by heating pads or heated blankets can provide short-term relief 1. In terms of medication, acetaminophen is a reasonable first-line option due to its favorable safety profile and low cost, although it is slightly weaker as an analgesic compared to NSAIDs 1. Some key points to consider in self-management include:
- Using a medium-firm mattress, as firm mattresses are less likely to lead to improvement in patients with chronic low back pain 1
- Avoiding the use of lumbar supports and cold packs due to insufficient evidence supporting their effectiveness as self-care options 1
- Considering the use of NSAIDs for pain relief, despite their associated gastrointestinal and renovascular risks 1
- Maintaining an active lifestyle within pain limits, rather than resting completely, to prevent deconditioning and promote recovery
- Incorporating stress-reduction techniques and proper posture maintenance to reduce muscle tension and improve overall well-being.
From the FDA Drug Label
Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living
The answer to self-management of low back pain is not directly addressed in the provided drug labels. However, cyclobenzaprine can be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 2.
- Rest
- Physical therapy are mentioned as part of the treatment. However, the labels do not provide information on self-management of low back pain.
From the Research
Self-Management Strategies for Low Back Pain
- The most common strategies used by participants to manage their chronic low back pain were medication, exercise, and application of heat 3
- Exercise is an effective strategy in the management of both chronic low back pain and osteoarthritis, although it is unclear what the optimum exercise is 4
- Core components of self-management strategies include exercise, education, and psychological interventions, but there was a lack of consistency with respect to content 5
Role of Healthcare Professionals in Self-Management
- Physiotherapists described exercises, particularly those aimed at improving core strength, as the main strategy that they encouraged people to use 3
- General practitioners regarded themselves as primarily having three roles: prescription of pain medication, dispensing of sickness certificates, and referral to specialists 3
- Clinicians should empower people with low back pain to self-manage their pain and provide knowledge and skills to make good decisions related to low back pain and general health 6
Effectiveness of Self-Management Programs
- Consistent evidence shows that self-management programs for osteoarthritis are effective in addressing pain and function, but effect sizes are small and might be clinically negligible 4
- Educational programs for patients with back pain are effective in an occupational setting and if combined with an exercise program 4
- The selfBACK app, an evidence-based, individually tailored self-management support system, was found to be effective in reducing pain-related disability at 3 months, although the improvement was small and of uncertain clinical significance 7
Challenges and Future Directions
- There is a need for a consensus on the key components of self-management interventions and how they should be evaluated 5
- Current self-management approaches do not consider the complex biopsychosocial nature of chronic low back pain 5
- Further research is needed to determine whether self-management can effectively manage chronic low back pain and to refine self-management programs to increase their effectiveness 5, 7