In 2007, the American College of Physicians came down hard on the issue of lower back pain. It recommended that the MRI no longer be used to identify the cause of lower back pain because in a 20 year literature search they established in more then 85% of cases the cause could not be attributed to spinal abnormalities like herniated discs and stenosis. They also pointed out that the identification of these structural variations created stress in the people hearing about them and caused them to believe that some time of intervention was needed just because they were identified even though they were not eliciting a symptom. They directly pointed out that unnecessary treatments and procedures were being performed simply because of the identification of these structural variations at the time the person was having pain and it was also leading to a massive rise in unnecessary costs.
Fast forward 10 years and they come out with their new recommendations for treating lower back pain and everything is off the table. there is absolutely no attempt to differentiate the cause of the pain. ZERO discussion about how to properly identify which tissue is eliciting the pain. ZERO discussion about the failings of the past 10 years in trying to treat lower back pain based on the findings of MRIs. This is appalling. This is in a sense an inadvertent endorsement of that way the system is running leaving 130 million adults Americans in chronic and 22 million Americans addicted to prescription pain medication.
Here are the latest recommendations:
RECOMMENDATION 1:
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).
RECOMMENDATION 2:
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).
RECOMMENDATION 3:
In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence).
Let’s look at each of these and see how they simply reinforce improper beliefs about how to resolve lower back pain. #1- Most lower back pain resolves over time regardless of treatment? Maybe they need to speak to the 130 million suffering with chronic pain. I believe they would have a difference of opinion. #2-For those suffering with chronic lower back pain choose one of 13 different types of treatment. How would any of these treatments work without identifying which tissue is in distress and emitting the emergency symptom of pain. Clearly if it were muscle, that would require a specific type of treatment, if it were nerve that would be different, if it were bone that would be different. This is absolutely moronic. Almost everyone of those 130 million people has tried almost everyone of these 13 types of treatment and it didn’t work because they are not based on identifying and addressing a specific tissue in distress creating the pain at the lower back. They are mostly involved in trying to alter your awareness of the pain signal itself. Completely useless and baseless. #3- If all of these 13 types of treatments fail, then go to medications to address the pain. They just presented the fact that they have no way of identifying the cause of the pain because if you resolve the cause there would be no reason for the body to continue eliciting the signal indicating that a tissue is in distress and the pain would simply cease. They are indicating that they are surrendering to their ineptness and are now focusing on trying to mask the pain signal. This implies that the cause will never be identified and therefore chronic pain is inevitable and forever.
I am enraged with this presentation. Most likely political pressure was put on this organization to present this futile, worthless and inept description of how to address lower back pain. As a person suffering with chronic pain, you must come to the conclusion from this display that nobody is looking out for your back. As far as this organization is concerned, you will die with your chronic pain in tow. I beg and implore you to find the Yass method and learn how it actually interprets the body’s presentation of symptoms to properly identify the tissue eliciting the symptoms do to being in distress. It is your one chance to end your pain, regain your function and reclaim your life. Clearly nobody is going to help you but yourself! Get the Yass method now and change your life for good!
www.mitchellyass.com email: drmitch@mitchellyass.com