New ACP clinical guideline for treating low back pain
The American College of Physicians (ACP) have published their clinical practice guideline for treating nonradicular low back pain in the journal Annals of Internal Medicine. The guideline is based on a review of randomized controlled trials and observational studies conducted on noninvasive drug and non-drug treatments for low back pain.The ACP last published their clinical practice guideline in 2007. Since then, some of the evidence has changed, and the 2017 guidelines include evaluations of mindfulness-based therapies, motor control exercise (MCE), and tai chi.

The president of the ACP comments on the newly issued recommendations:

-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.

-Physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training."

-As the next clinical step for patients with chronic low back pain who did not respond well to nonpharmacological therapy, the ACP recommend nonsteroidal anti-inflammatory drugs, followed by drugs such as tramadol or duloxetine as second-line therapy.

Other recommendations issued by the ACP:
-Opioids should be 'last option' for treatment.
-Patients with chronic low back pain start by undergoing non-drug therapy and exercising, as well as engaging in multidisciplinary rehabilitation, acupuncture, mindfulness-based therapies for stress reduction, tai chi, and yoga.
-MCE (an activity that focuses on the "activation of the deep and global trunk muscles") and progressive muscle relaxation, including the use of electromyography biofeedback, In the initial stages of chronic low back pain.
-Biofeedback-assisted relaxation uses electronic devices to measure body functions, thus helping the patient gain control of muscle tension and relaxation.
-low-level laser therapy and spinal manipulation, as well as cognitive behavioral and operant therapy.