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There are a variety of recommendations for the treatment of Back pain, dependent on who you talk to. The optimal treatment usually varies from person to person as there are many causes of back pain, and everyone seems to respond individually to different therapies. The best recommendation I could give someone with low back pain that is not getting better as fast as one would like is to visit your local health care provider who specializes in back care (eg: doctor of chiropractic, doctor of osteopathy, doctor of physiatry, orthopedic surgeon, etc.).

A very thorough set of guidlines for the treatment of low back pain was released by the American College of Physicians in 2007 entitled: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society (Ann Intern Med. 2007;147:478-491). Anyone who reads these recommendations would note that there are many options for therapy, the key is to find one that works for you.

A very brief summary of the treatment recommendations of nonspecific or uncomplicated low back pain are:

Consider the use of drugs like NSAIDS in addition to the use of spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, Massage Therapy, yoga, cognitive-behavioral therapy, or progressive relaxation.

A more comprehensive summary is:

Recommendation 1: Patients with low back pain should be categorized into 3 broad categories:nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause.

Recommendation 2: Special imaging (x-ray, MRI, CT) should not be routinely performed for patients with nonspecific low back pain.

Recommendation 3: Special imaging and testing should be performed for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected.

Recommendation 4: Special imaging and testing should be performed for patients with persistent low back pain when they are good potential candidates for surgery.

Recommendation 5: Clinicians should provide patients with good evidence-based information.

Recommendation 6: For patients with low back pain, clinicians should consider the use of acetaminophen or nonsteroidal anti-inflammatory drugs (after consideration of the risks) in addition to back care information and self-care (exercise and stretching).

Recommendation 7: For patients who do not improve with selfcare options (exercise and stretching), clinicians should consider the addition of spinal manipulation (for chronic or subacute low back pain), intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation.

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