From the Guidelines
For patients with mechanical back pain, clinicians and patients should select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation as first-line therapy. This approach is supported by the American College of Physicians' clinical practice guideline, which recommends nonpharmacologic treatments for acute, subacute, and chronic low back pain 1. The guideline suggests that patients with acute or subacute low back pain improve over time regardless of treatment, and therefore, nonpharmacologic treatments with moderate-quality evidence, such as superficial heat, or low-quality evidence, such as massage, acupuncture, or spinal manipulation, should be selected.
When considering pharmacologic treatment, nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants should be chosen as they have moderate-quality evidence supporting their use 1. However, it is essential to note that these treatments should only be considered if nonpharmacologic therapies are not effective or if patients have a strong preference for pharmacologic treatment.
For patients with chronic low back pain, exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation should be considered as initial nonpharmacologic treatments 1. These treatments have moderate-quality evidence supporting their use and can be effective in managing chronic low back pain.
In cases where nonpharmacologic therapy is inadequate, nonsteroidal anti-inflammatory drugs can be considered as first-line pharmacologic therapy, followed by tramadol or duloxetine as second-line therapy 1. However, opioids should only be considered as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients, after a discussion of known risks and realistic benefits with patients.
Some key points to consider when treating mechanical back pain include:
- Avoiding prolonged bed rest, which can weaken muscles
- Maintaining good posture throughout the day
- Using a medium-firm mattress and placing a pillow between the knees when sleeping on the side
- Considering physical therapy for personalized exercise programs and techniques
- Monitoring for symptoms that may indicate more serious conditions, such as numbness, tingling, or weakness in the legs, and seeking medical attention if these symptoms occur.
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
To treat mechanical back pain, cyclobenzaprine hydrochloride tablets can be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions. The treatment should be used only for short periods (up to two or three weeks).
- Key benefits: relief of muscle spasm and its associated signs and symptoms, such as pain, tenderness, limitation of motion, and restriction in activities of daily living.
- Important consideration: cyclobenzaprine hydrochloride tablets should be used with caution and under the guidance of a healthcare professional 2 2.
From the Research
Treatment Options for Mechanical Back Pain
- Mechanical back pain can be treated using conservative and invasive methods, with the choice of treatment depending on factors such as the duration and severity of pain, as well as diagnostic reports 3.
- Conservative treatment may include maintaining activity levels and function, with specific emphasis on patient education, therapeutic exercises, and bracing 4.
- Physical therapy and manual medicine can also be used to treat mechanical back pain, with techniques such as education, exercise, lumbar traction, manual manipulation, and application of heat or cold therapy 5.
- Medications such as ibuprofen and acetaminophen may be used to treat acute low back pain, but continuous low-level heat wrap therapy has been shown to be more effective in some cases 6.
Invasive Treatment Options
- Invasive treatment options, such as interventional and surgical procedures, may be considered for patients with long-lasting back pain that has not responded to conservative treatment 3.
- The choice of invasive treatment will depend on the underlying cause of the back pain, as well as the patient's overall health and medical history 7.
- Common causes of mechanical back pain that may require invasive treatment include spinal stenosis, herniated discs, zygapophysial joint pain, and vertebral fractures 7.
Multidisciplinary Approach
- A balanced approach to treating mechanical back pain, taking into account patient psychosocial factors and incorporating multidisciplinary care, can increase the likelihood of success 7.
- This may involve a team of healthcare professionals, including physicians, physical therapists, and other specialists, working together to develop a comprehensive treatment plan 4.