Don’t be surprised the next time you visit a doctor for back pain, that the doctor recommends you seek other therapies and exercises like yoga and Pilates for the pain.

Since February 2017, the American College of Physicians have recommended doctors not to prescribe medication as the first line of treatment for back pain. Concerns that strong painkillers can lead to a life-long dependency and even addiction to drugs have prompted a change in the medical guidelines. The change also comes as new studies showed painkillers provide only temporary relief, and are not helpful in the long run.

The United States has the highest death rate from drug abuse in the developed world. The addiction often starts innocently from a doctor’s prescription for an ailment like back pain.

Several high-profile deaths, linked to prescriptive drugs, highlighted the problem. Singer Prince (1958 – 2016) who rocked to stardom with “Purple Rain,” and guitarist Tom Petty (1950 – 2017,) known for his strings of hit songs like “Amercian Girl” and “Free Fallin’” both died from a drug overdose. They were addicted to prescriptive drugs after suffering from chronic hip pain.


“We need to look at therapies that are non-pharmacological first,” Dr Nitin Damle, president of the group’s board of regents was quoted to have said in a report by the New York Times. The new guidelines recommend doctors avoid prescribing anti-inflammatories or muscle relaxants. Steroid injections are not helpful, and neither is acetaminophen like Tylenol for back pain, the guidelines said.

Doctors should suggest patients try alternative therapies like exercise, acupuncture or massage therapy. Over-the-counter painkillers such as, aspirin, naproxen or ibuprofen can also provide some relief. The guidelines did not address back surgery but focused on non-invasive treatments.


For most people with acute back pain there is no need to see a doctor, according to Dr. Rick Deyo, a spine researcher and professor at the Oregon Health and Science University in Portland, Oregon and an author of the new guidelines.

In medical term, an acute back pain is defined as a pain, present for four weeks or less. The pain also does not radiate down the leg.

“For acute back pain, the analogy is to the common cold,” Dr. Deyo said in the interview with the New York Times. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious. ”

Even those with chronic back pain — lasting at least 12 weeks — should start with non-pharmacological treatments, the guidelines say. If patients still want medication, they can try over-the-counter drugs like ibuprofen or aspirin. In Singapore, the more common over-the-counter painkiller is paracetamol, such as Panadol.


Scans like an MRI scan for diagnosis are “worse than useless” for patients with back pain, members on the board of the American College of Physicians were quoted to have said in telephone interviews with the New York Times. The results can be misleading, as they show what look like abnormalities, but are actually not related to the pain, they said.

The New York times also asked doctors whether the new guidelines will be adopted:

The prospect is not good: “Patients are looking for a cure,” said Dr. Steven J. Atlas, a back pain specialist at Massachusetts General Hospital, who wrote an editorial accompanying the article on the new recommendations.

“The guidelines are for managing pain (rather than a cure.)”

From the medical point of view, there is no cure for back pain, but to wait out the pain or seek alternative treatments which have shown to be helpful.


However, doctors and patients would choose medication, scans and injections because of the incentives. Medical insurance contributes to the treatment problem, experts said. Insurance companies do not pay for remedies like mindfulness training or soft-tissue manipulations. These remedies — though less costly than medication —  are not cheap, and are not covered by the insurance.

Dr. Atlas who wrote the editorial accompanying the new guidelines admitted, “It is much easier to get a shot than to get a mind-body or cognitive behaviour therapy.”

Some 80% of the population will suffer from back pain in their lifetime. Of those who have been treated for back pain, 85% will have a recurrence within one year, and will go on to develop chronic lower back pain.

Although back pain is not seen as life-threatening, it is the most common cause of work disability. It is also the most common reason given for sick leaves.


Gina Kolata. (13 Feb 2017). Lower Back Ache? Be Active and Wait It Out, New Guidelines Say. New York Times. Retrieved from

Karen Hsu. Low Back Pain and Rock Climbing. Retrieved from

Sickness absence – work related causes – back pain. The Institute of Occupational Medicine (IOM,) UK. Retrieved from

Low Back Pain – What it is. Singhealth. Retrieved from

Last updated March 10, 2019.

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