American College of Physicians issues guideline for treating nonradicular low back pain

1. Acupuncture, massage or spinal manipulation is the top choice for treating nonradicular low back pain
2. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.
3. Approximately one quarter of U.S. adults reported having low back pain lasting at least one day in the past three months. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks, and chronic (lasting more than 12 weeks).
4. Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.
5. Low-quality evidence showed that systemic steroids were not effective in treating acute or subacute low back pain.
6. For the treatment of chronic low back pain, physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another.