From the Guidelines
For patients with low back pain, clinicians should provide evidence-based information on the expected course, advise patients to remain active, and provide information about effective self-care options. This approach is supported by the American College of Physicians and the American Pain Society's joint clinical practice guideline 1. The treatment guideline for someone with complaints of lower back pain should prioritize conservative measures, including:
- Providing patients with evidence-based information on low back pain with regard to their expected course
- Advising patients to remain active
- Providing information about effective self-care options, such as staying active and using medications with proven benefits
- Considering the use of medications like acetaminophen or nonsteroidal anti-inflammatory drugs for patients with low back pain, while assessing severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
When it comes to diagnostic testing, clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain, unless severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination 1. For patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis, magnetic resonance imaging (preferred) or computed tomography may be considered only if they are potential candidates for surgery or epidural steroid injection 1.
Nonpharmacologic therapy with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may be considered for patients who do not improve with self-care options 1. However, the evidence for these therapies is moderate, and the recommendation is weak.
Overall, the goal of treatment is to reduce pain, improve function, and enhance quality of life, while minimizing the risks of unnecessary testing and treatment.
From the FDA Drug Label
Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The treatment guideline for someone with complaints of lower back pain is to take 400 mg of ibuprofen every 4 to 6 hours as necessary for relief of pain 2.
- The dose should be tailored to each patient, and may be lowered or raised depending on the severity of symptoms.
- In general, the smallest dose of ibuprofen that yields acceptable control should be employed. Alternatively, cyclobenzaprine hydrochloride tablets 5 mg can be used, with a significant improvement in global impression of change, medication helpfulness, and relief from starting backache 3.
- The efficacy of cyclobenzaprine hydrochloride tablets 5 mg was demonstrated in two seven-day, double-blind, controlled clinical trials.
- Physician-assessed secondary endpoints also showed that cyclobenzaprine hydrochloride tablets 5 mg was associated with a greater reduction in palpable muscle spasm than placebo.
From the Research
Treatment Guidelines for Lower Back Pain
The treatment guidelines for lower back pain are as follows:
- For acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods 4.
- For chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions 4.
- Nonpharmacologic treatments such as physical therapy, chiropractic care, massage therapy, and acupuncture are also recommended for chronic low back pain 5.
- The American College of Physicians (ACP) guideline recommends nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic low back pain 5.
Medications for Lower Back Pain
- NSAIDs are slightly more effective than placebo for short-term reduction of pain intensity and improvement in disability 6.
- There is no clear difference in short-term pain reduction when comparing selective COX-2 inhibitors to non-selective NSAIDs 6.
- Cyclobenzaprine and naproxen versus naproxen alone can be used for the treatment of acute low back pain and muscle spasm, with combination therapy being associated with less objective muscle spasm and tenderness 7.
Non-Pharmacologic Treatments
- Exercise therapy is recommended for the treatment of chronic low back pain 4.
- Psychosocial interventions are also recommended for the treatment of chronic low back pain 4.
- Physical therapy, chiropractic care, massage therapy, and acupuncture can be used as nonpharmacologic treatments for chronic low back pain 5.