The American College of Physicians has updated their current guidelines on treating low back pain – and there are some surprises.

Published in Annals of Internal Medicine, the ACP’s primary recommendation is to avoid using any drug-based treatment as a first option, and instead opt for non-drug approaches: exercise, rehab, acupuncture, mindfulness meditation, tai chi, yoga, biofeedback, spinal manipulation and cognitive behavioral therapy.

The authors of these guidelines looked to a systematic review, conducted by the ACP, that looked at those treatments and over-the-counter and prescription painkillers (acetaminophen –Tylenol– NSAIDs — Advil and Aleve– duloxetine –Cymbalta– tricyclic antidepressants, benzodiazepines and steroids). The authors examined how well all helped with short-term and long-term pain relief, function, and improvement in mood, as well as whether these patients would eventually need surgery.

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