Selecting a Treatment Regimen Table 5. Management of LBP: Interventions LBP Duration Self-care
Pharmacologic therapy
Advice to remain active Books, handout
Application of superficial heat Acetaminophen NSAIDs
Nonpharmacologic therapy
Skeletal muscle relaxants Antidepressants (TCA) Benzodiazepines Tramadol, opioids Spinal manipulation Exercise therapy Massage
Acupuncture Yoga
Cognitive-behavioral therapy Progressive relaxation
Intensive interdisciplinary rehabilitation
(< 4 weeks) •
Acute
• • • • •
• • •
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
and burden OR risks and burden clearly outweigh benefits
Benefits clearly outweigh risks High
Moderate Low
Strong Strong Strong
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 aſter 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.
Benefits finely balanced with risks and burden
Weak Weak Weak
