- Jennifer Middleton, MD, MPH
The article on "Mechanical Low Back Pain" in the current issue of AFP provides an overview of diagnosis and treatment for the 1 in 5 adults who suffer from low back pain. The article reminds us that NSAIDs alone work just as well as opioids, muscle relaxers, and/or oral corticosteroids. Non-pharmacologic pain relief is emphasized, with some evidence of benefit found with physical therapy, osteopathic manipulative treatment, and exercise. Patients want more than just exercise advice, though; they also want to have their experiences with both pain and exercise considered to develop personalized recommendations.
Patients want physicians to listen to their prior experiences with back pain and exercise, taking their perceived fitness ability into account when recommending exercise. They prefer plans that consider their exercise likes and dislikes. Patients also want an exercise plan that they feel they can be successful with, partially because they fear judgment from their physician if they don't improve. Validating patients' experiences with their pain, eliciting their exercise preferences, and having resources to discuss with patients may increase the likelihood of their success with a new exercise regimen.
Engaging regularly in exercise is challenging for many people, let alone someone with chronic low back pain. Simply counseling patients regarding physical activity is a critical first step, one that many patients don't ever recall hearing from their physician. Working with patients to create a tailored exercise prescription may help. Several fitness apps, as recently reviewed in FPM, also provide a wide range of motivational methods, from raising money for charity to running from simulated zombie chases.
AFP has additional resources you may find useful, including the AFP By Topic on Health Maintenance and Counseling along with patient education at familydoctor.org, where "sports and exercise at every age" is the site's current monthly focus.