Selecting a Treatment Regimen
Table 5. Management of LBP: Interventions
LBP Duration
Acute
(< 4 weeks)
Self-care
Pharmacologic
therapy
Nonpharmacologic
therapy
Advice to remain active
Books, handout
Application of superficial heat
Acetaminophen
NSAIDs
Skeletal muscle relaxants
Antidepressants (TCA)
Benzodiazepines
Tramadol, opioids
Spinal manipulation
Exercise therapy
Massage
Acupuncture
Yoga
Cognitive-behavioral therapy
Progressive relaxation
Intensive interdisciplinary
rehabilitation
Subacute or
Chronic
(> 4 weeks)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
• Interventions supported by grade B evidence (at least fair-quality evidence of moderate benefit, or small
benefit, but no significant harm, cost, or burden).
No intervention was supported by grade A evidence (good-quality evidence of substantial benefit).
American College of Physicians Guideline Grading System
Quality of Evidence
Strength of Recommendation
Benefits clearly outweigh risks
and burden OR risks and burden
clearly outweigh benefits
Benefits finely balanced with
risks and burden
High
Strong
Weak
Moderate
Strong
Weak
Low
Strong
Weak
Insufficient evidence to determine net benefits or harms
Adopted from the classification developed by the Grading of Recommendations, Assessment, Development,
and Evaluation (GRADE) workgroup.
Disclaimer
This Guideline attempts to define principles of practice that should produce high-quality patient care.
It focuses on the needs of primary care practice, but also is applicable to providers at all levels.
This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining
the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by
the clinician after consideration of each individual patient situation.
Neither IGC, the medical associations, nor the authors endorse any product or service associated with the
distributor of this clinical reference tool.
