From the Guidelines
Management of low back pain should prioritize a multi-faceted approach combining non-pharmacological measures, physical therapy, and lifestyle modifications, with a focus on maintaining normal activities, applying heat, and utilizing first-line medications like NSAIDs or acetaminophen as needed. For acute low back pain, non-pharmacological measures such as maintaining normal activities as tolerated and applying heat are recommended 1. First-line medications include NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, with acetaminophen (650-1000mg every 6 hours, not exceeding 4000mg daily) as an alternative for those who cannot take NSAIDs 1. Muscle relaxants like cyclobenzaprine (5-10mg three times daily) can be added for severe muscle spasms for short durations (3-7 days) 1.
For persistent pain, physical therapy focusing on core strengthening exercises, stretching, and proper body mechanics is essential, along with cognitive behavioral therapy to manage chronic pain by addressing psychological factors 1. It is crucial to avoid bed rest beyond 1-2 days as it can worsen outcomes 1. Maintaining proper ergonomics during daily activities, engaging in regular low-impact exercise like walking or swimming, and practicing weight management to reduce strain on the back are also vital components of low back pain management 1. These approaches work by reducing inflammation, relieving muscle tension, improving spinal stability, and addressing the biopsychosocial aspects of pain perception.
Key considerations include:
- Maintaining activity levels to prevent deconditioning and promote recovery
- Utilizing heat for short-term relief of acute low back pain
- Selecting appropriate medications based on patient-specific factors and potential side effects
- Incorporating physical therapy and cognitive behavioral therapy for comprehensive pain management
- Encouraging lifestyle modifications such as proper ergonomics, regular exercise, and weight management to reduce the risk of chronic low back pain.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Low Back Pain
- Low back pain is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population 2
- The management of low back pain can be based on a mechanistic approach, and developing more effective multidisciplinary treatment is possible 3
Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation are recommended for acute low back pain 2
- For subacute low back pain, the guidelines recommend the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation 2
- For chronic low back pain, the guidelines recommend therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture 2
- Adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up in patients with acute low back pain 4
Clinical Guidelines
- Clinical practice guidelines (CPGs) have been issued in various countries around the world to rationalize the management of low back pain 2
- A total of 22 CPGs were identified, and they exhibited heterogeneity in their recommendations, particularly in the approach to different stages of low back pain 2
- The available evidence on the effectiveness of 10 common approaches to the management of non-specific low back pain has been mapped, and substantial evidence is available for each management approach except for patient reassurance 5
- New guidelines have been developed for the management of low back pain, introducing concepts such as early identification of low back pain at risk of chronicity and quicker intensive and multidisciplinary management if necessary 6