Your aching back: Try pill-free treatments first

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Confused about how to treat lower back pain? New guidelines from the American College of Physicians (ACP) recommend pill-free therapies over medication. The guidelines, published online Feb. 14, 2017, by Annals of Internal Medicine, focus only on pain limited to the lower back — not the kind that radiates down the leg and causes weakness or numbness.

Researchers reviewed more than 150 studies about various back pain treatments. They concluded that for temporary back pain that may heal within 12 weeks, it's best to try heat wraps, massage, acupuncture, or spinal manipulation first. If any medications are used, the ACP recommends only nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. Acetaminophen (Tylenol) is no longer recommended; new evidence suggests that it doesn't work for low back pain.

For chronic low back pain, the ACP suggests a long list of pill-free therapies, such as mindfulness-based stress reduction, tai chi, yoga, relaxation techniques, and cognitive behavioral therapy. If those don't work, the ACP says it may help to prescribe NSAIDs, such as ibuprofen (Advil); the antidepressant duloxetine (Cymbalta); or, as a last resort, the opioid tramadol (Conzip, Ultram). But the ACP warns that all of the medications may have side effects, some of them very risky for health.

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