Associate Professor Sean Rundell, PT, DPT, PhD, served on the Guideline Development Group for Assessment and Treatment of Acute Low Back Pain: A Multidisciplinary Clinical Practice Guideline, published in Pain Medicine.
Dr. Rundell represented physical therapy on the interdisciplinary panel and contributed expertise in epidemiology. The group provided input on the guideline development process, reviewed evidence from a systematic review, discussed and voted on recommendations, and reviewed the final manuscript.
The guideline includes recommendations for patients, in addition to recommendations for clinicians.
"The new and fairly unique part of these guidelines is that they provide recommendations directly to patients to inform self-management strategies, in addition to recommendations for clinicians," Rundell said.
For people with acute low back pain who do not have symptoms suggesting a serious underlying condition, the guideline recommends learning what to expect and when to seek medical care. People should continue their usual low-impact activities as tolerated and adjust activity as needed. The guideline also emphasizes that movement is safe. Superficial heat and short-term use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used.
For patients whose pain does not improve after one to two weeks of self-management, the guideline recommends that clinicians consider one or more treatment options. These include exercise-based physical therapy, manipulation and mobilization, acupuncture, optimization of NSAID use, and skeletal muscle relaxants. Patients at risk of chronic low back pain should consider psychologically informed physical therapy, which combines physical rehabilitation with strategies that address thoughts, feelings, and behaviors that can affect recovery.
The guideline also recommends against routine imaging for most cases of acute low back pain. Research found that early imaging does not improve pain, function, or quality of life for people without signs of a serious underlying condition and may lead to unnecessary tests or procedures. The guideline also recommends against routine use of opioids, citing limited benefit for acute low back pain and increased risk of side effects.