New Recommendations for Back Pain

open hands on back left

Huge news! The American College of Physicians just released new guidelines that recommend trying nonpharmacological therapies (like massage therapy!) for back pain before turning to pain relievers and anti-inflammatory medicines.

According to an article in the New York Times, in the wake of opioid addiction that too often begins with a prescription for conditions like back pain, a number of states (including Florida) have cracked down on medical establishments (often nicknamed “pill mills”) that over-prescribe pain killers. This situation has caused many physicians to rethink their own prescribing habits.

And now the medical organization that many doctors belong to—the American College of Physicians—has reconsidered the effectiveness of prescribing pain killers for back pain to begin with. The new guidelines encourage doctors to tell patients to try alternative therapies like “exercise, acupuncture, massage therapy or yoga”—and reassure their patients that they will get better no matter which route they choose.

I was discussing this article with a client the other day, and she told me that years ago her son was in an accident and suffered debilitating back pain from it. After seeking treatment from a doctor, she was told that there were three courses of action they could choose from: surgery, injections, or doing nothing. The doctor told her studies showed that over a 3-5 year period, no matter which path a patient chose, the outcome was the same. So they chose to avoid surgery and injections, her son received physical therapy and massage therapy, and sure enough, over time, he made a complete recovery.

But that doctor may have been the exception. It seems to me that doctors want to do something, they want to offer a solution, so they offer pain medicine, injections, or procedures. It wasn’t until early in my practice (which was later in my life) that I learned from a chiropractor that a “typical” back strain produces a very normal inflammatory response—it’s what our bodies need to do to work through trauma—and it typically resolves in 3-5 days with no intervention.

We are just so accustomed to wanting, and getting, instant “gratification” or relief, that we don’t want to wait 3-5 days. We want someone to do something NOW. So many of us turn to a doctor, who might be tempted to offer medication that might provide instant relief. But the physicians interviewed for the NY Times article stated that usually there is no need to see a doctor for back pain at all. “For acute back pain,” one doctor states, “the analogy is to the common cold. It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious.”

Even for chronic back pain—pain lasting at least 12 weeks—doctors are now recommending that patients start with nonpharmacological therapies.

And finally, doctors are admitting that scans like MRI are “worse than useless” for back pain patients, because the results can be misleading. One of my physical therapy colleagues told me this years ago—that if someone went to the doctor for back pain and a scan revealed an irregularity like a bulging disc, they’d probably order surgery or some treatment for the bulging disc, but in reality the bulging disc might not be the cause of the pain at all. Most of us, at a certain age (after years of wear and tear), have at least one bulging disc in our spines, but many of us never have any issues from it. So discovering it in a scan is not necessarily all that helpful.

Now many doctors are telling patients to skip the scan and try alternative therapies first. The new recommendations include:

Stay active. Practices like yoga, stretching, and Tai Chi are great. But you don’t have to start a new regimen—if there’s something you already like to do, do that!
Think positive. A patient has to believe that they can get better.
Keep expectations in check. These are guidelines for managing pain rather than “curing” pain. Alternative therapies can take time, but ultimately can be quite effective.

The physicians interviewed admitted that one challenge to this approach is that the insurance industry is not geared toward paying for things like massage, mindfulness training or chiropractic adjustments. It’s actually easier to get approval for an injection! But in the long run, we have to think about which course of action will yield the best results.

One physician says, “What we need to do is to stop medicalizing symptoms.” He tells patients, “I know your back hurts, but go run, be active, instead of taking a pill.”

Therapies like massage and reflexology can help with pain relief and healing, easing the stress (and worry) that can accompany pain. I personally am not anti-medication by any means, but I am happy when doctors see the value in “alternative” therapies and feel comfortable recommending them to their patients.


pill explosion

Category : Blog &Health &Massage Therapy Posted on February 22, 2017

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