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No more pain meds for lower back pain

Photo: Don't expect pain meds for lower back pain
A review shows the modern day management of lower back pain does not involve strong prescription medication but physiotherapy and exercise.

Patients with lower back pain shouldn't expect to receive prescription medication from their family doctor as international treatment guidelines respond to the opioid crisis.

A University of Sydney review of the management of lower back pain (LBP) - the leading cause of disability worldwide - has found patients are more likely to be recommended yoga and exercise as treatment options.

"Until now, the recommended approach to help LBP in general practice was to prescribe simple pain medicines such as paracetamol or anti-inflammatories," said lead author Dr Adrian Traeger, researcher from the Musculoskeletal Health Group at the University's School of Public Health.
But the review shows there's been a "substantial change in thinking".

"If you have an uncomplicated case of recent-onset LBP, your doctor may now simply provide advice on how to remain active and non-drug methods for pain relief such as heat and massage, and arrange to see you in two weeks to make sure the pain has settled," said Dr Traeger.

"Everyone is aware of the opioid crisis, that's a global problem, so they are really trying to find a different approach to management that would not start with these prescription drugs."

The guidelines for the UK's National Institute for Health and Care Excellence - released at the end of last year - and the American College of Physicians also discourage other invasive treatments such as injections and surgery.

There are currently no official National Health and Medical Research Council guidelines for the front line management of lower back pain management in Australia.

However Dr Evan Ackermann from the Royal Australian College of General Practitioners (RACGP) says a non-pharmalogical approach to LBP has already started to filter through here.

"That's where its be going for the last few years because most of the causes of lower back pain are mechanical, treatment is about movement and getting people mobile," he told AAP.

Dr Ackermann says only about five per cent of lower back pain presentations will be serious and for most patients strong painkillers are not the answer.

He says what patients should expect from their doctors is a full examination and evaluation to determine the underlying cause for the back pain.

"That's the critical thing," said Dr Ackermann.

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