From the Guidelines
Management of low back pain should prioritize a graduated return-to-work approach, with initial limitations on heavy lifting, prolonged sitting or standing, and repetitive bending or twisting, to balance the need for recovery with the benefits of maintaining work engagement. When considering work restrictions, factors such as the patient's age, general health, and physical demands of required job tasks should be taken into account 1. However, evidence is insufficient to guide specific recommendations about the utility of modified work for facilitating return to work 1.
For most patients with acute low back pain, conservative management is recommended, including a short period of relative rest (1-2 days), followed by gradual return to activities. Medications typically include acetaminophen (500-1000mg every 6 hours as needed) or NSAIDs such as ibuprofen (400-800mg three times daily with food) for pain relief 1. Muscle relaxants like cyclobenzaprine (5-10mg three times daily) may be added for muscle spasms. Physical therapy focusing on core strengthening, flexibility, and proper body mechanics should be initiated within 1-2 weeks of onset.
Some key considerations for work restrictions include:
- Initial limitations on heavy lifting (nothing over 15-20 pounds)
- Prolonged sitting or standing (limit to 30-45 minutes before changing positions)
- Repetitive bending or twisting These restrictions should be progressively reduced as symptoms improve, typically over 2-4 weeks. Employers should be encouraged to provide ergonomic assessments and workplace modifications such as adjustable chairs, standing desks, or assistive devices for lifting. Regular communication between healthcare providers, patients, and employers facilitates successful return to work, as prolonged inactivity can lead to deconditioning and delayed recovery 1.
In patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, or spinal manipulation 1. If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants as first-line therapy, with opioids considered only as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients 1.
From the Research
Management and Treatment Options for Low Back Pain
- The management of low back pain involves a multidisciplinary approach, including non-pharmacologic and pharmacologic treatments 2, 3, 4.
- Non-pharmacologic treatments, such as counseling, exercise therapy, spinal manipulation, and physical therapy, are considered first-line management for chronic low back pain 2.
- Pharmacologic interventions, including nonsteroidal anti-inflammatory drugs (NSAIDs) and duloxetine, may be used as second-line treatment for chronic low back pain 2, 5.
- The use of NSAIDs for chronic low back pain has been shown to be effective in reducing pain intensity and disability, although the magnitude of the effects is small and the level of evidence is low 5.
Work Restrictions and Return to Work Strategies
- Patients with chronic low back pain should avoid bed rest and be encouraged to remain active and return to work as soon as possible 2.
- A gradual return to work strategy, including modified duties and flexible work arrangements, may be beneficial for individuals with chronic low back pain 4.
- Employers and healthcare providers should work together to develop a return to work plan that takes into account the individual's physical and psychological limitations 6.
Prevention of Chronic Low Back Pain
- Prevention of chronic low back pain is an important aspect of management, and screening tools are available to predict the progression from acute to chronic low back pain 2.
- Targeted treatment strategies, including education and exercise programs, may be beneficial for preventing the progression of acute to chronic low back pain 2.
- A biopsychosocial approach, considering social, psychological, and biological factors, should be used to develop prevention and treatment plans for low back pain 4.