Med/Psych Update

The truth about treating low back pain

Current Psychiatry. 2010 July;9(7):38-40

References

1. Bair MJ, Robinson RL, Katon W, et al. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433-2445.

2. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-258.

3. Rush AJ, Polatin P, Gatchel RJ. Depression and chronic low back pain: establishing priorities in treatment. Spine (Phila Pa 1976). 2000;25(20):2566-2571.

4. Kroenke K, Bair MJ, Damush TM, et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301(20):2099-2110.

5. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

6. Hagen KB, Hilde G, Jamtvedt G, et al. Bed rest for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2004;(4):CD001254.-

7. Burton AK, Waddell G, Tillotson KM, et al. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine (Phila Pa 1976). 1999;24(23):2484-2491.

8. Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract. 2002;52:119-123.

9. van Tulder MW, Scholten RJ, Koes BW, et al. Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine (Phila Pa 1976). 2000;25:2501-2513.

10. Staiger TO, Gaster B, Sullivan MD, et al. Systematic review of antidepressants in the treatment of chronic low back pain. Spine (Phila Pa 1976). 2003;28:2540-2545.

Clinical Point

Cognitive-behavioral therapy may improve subacute or chronic low back pain

Multiple nonpharmacologic therapies have small-to-moderate benefits for low back pain (Table 2). In acute low back pain (<4 weeks), spinal manipulation often is useful. Subacute low back pain (4 to 8 weeks) may improve with intensive interdisciplinary rehabilitation, including cognitive-behavioral therapy (CBT), and can increase functional status and reduce work absenteeism. For chronic low back pain, CBT or progressive relaxation, spinal manipulation, acupuncture, and other modalities have mild to moderate effectiveness.

Table 2

Nonpharmacologic modalities for low back pain

Duration of back pain	Treatment modality
Acute (<4 weeks)	Spinal manipulation
Subacute (4 to 8 weeks)	Intensive interdisciplinary rehabilitation (physician consultation, psychological and physical therapy, social and vocational intervention, cognitive-behavioral therapy [CBT])
Chronic (>8 weeks)	Acupuncture, exercise, massage therapy, yoga, CBT, progressive relaxation, spinal manipulation, intensive interdisciplinary rehabilitation
Source: Reference 5

Related resources

Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79(12):1067-1074.
Exercise for a better back. www.backcare.org.uk/CMS/files/702-exercise-for-a-better-back.pdf. Accessed April 12, 2010.

Drug brand names

Cyclobenzaprine • Flexeril
Tramadol • Ultram, Ultram ER

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

The truth about treating low back pain

References

Pages

Recommended Reading