Low back pain: joint guidelines from US Departments of Veterans Affairs, Defense

  • J Gen Intern Med

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The US Department of Veterans Affairs and Department of Defense have released a joint Clinical Practice Guideline (CPG) for the diagnosis and treatment of low back pain (LBP).
  • Several pharmacological treatment recommendations differ from those of other guidelines.

Why this matters

  • Studies suggest the incidence of significant back pain in veterans is higher than in nonveterans.

Key differences with other recommendations

  • The CPG strongly recommends against initiating long-term opioid therapy, and that any opioid therapy be low dose and short in duration, whereas the 2017 American College of Physicians (ACP) recommends that opioids be considered for patients who have failed other treatments.
  • The CPG also strongly recommends against the use of benzodiazepines, oral/intramuscular steroid medications, and chronic use of oral acetaminophen, whereas the ACP offers less guidance.

Other recommendations

  • Imaging is not recommended for LBP lasting
  • Physical activity, self-care, and cognitive behavioral therapy are strongly recommended.
  • Spinal epidural steroid injections are not recommended for long-term reduction of radicular low back pain, nonradicular low back pain, or spinal stenosis.
  • NSAIDs are recommended for acute or chronic LBP; duloxetine is also an option for chronic LBP.