The American Physicians made recommendations both for acute and chronic low back pain. For the acute situation they suggest heat treatment has the best evidence, followed by massage, acupuncture and manipulation. For chronic back pain (and this is the situation for most of our patients) they recommend acupuncture and also exercise, multidisciplinary rehabilitation and mindfulness as being best evidenced. Another nine recommended treatments have somewhat less sound evidence. What particularly stands out here is that these are all non-drug treatments; the drugs are held as back-up if the non-drug approaches don’t work. The authors explain that since there is no clear evidence for one treatment being better than another it makes sense to recommend those with the lowest harms and costs.
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