Clinical Practice Guideline

Low Back Pain

Diagnosis and Treatment of Low Back Pain

(Endorsed, April 2017)

The guideline, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain, was developed by the American College of Physicians and was endorsed by the American Academy of Family Physicians. 

Key Recommendations

  • Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain, as they will improve over time regardless of treatment.
  • When pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants should be used.
  • Nonpharmacologic treatment, including exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, biofeedback, low-level laser therapy, cognitive behavioral therapy, or spinal manipulation, should be used initially for most patients who have chronic low back pain.
  • For patients who have chronic low back pain and do not respond to nonpharmacologic therapy, NSAIDs should be used.  Tramadol or duloxetine should be considered for those patients who do not respond to or do not tolerate NSAIDs. Opioids should only be considered if other treatments are unsuccessful and when the potential benefits outweigh the risks for an individual patient. See full recommendation for further details.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.