For the 80%–90% of patients with chronic back pain for whom no specific cause can be found, the guidelines advise that physicians educate patients about appropriate self-care and prescribe acetaminophen or NSAIDs as first-line therapy. For patients in whom pain persists, nonpharmacologic approaches such as exercise and spinal manipulation may be tried, along with other “interdisciplinary” approaches such as acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation therapy.
A main goal of the workshop, Dr. Khalsa said, was to move beyond those measures to design approaches that can prevent chronic pain in the first place. “It's much better to be able to do something when the patient first walks in the door to identify and predict—and hopefully prevent—a long-term chronic, debilitating problem.”
Disclosures: Dr. Khalsa and Dr. Briggs are government employees with no financial conflicts. Dr. von Korff said he received funding only from the NIH, and Dr. Franklin stated that he has no disclosures.