Ep. 40 - Acute Low Back Pain Guideline - A Clinician's Perspective

Acute Low Back Pain Guideline: A Clinician's Perspective 

In this episode of the Pain Matters podcast, Host Sudheer Potru, DO, FASA, FASAM, and Co-Host Mustafa Broachwala, DO, delve into crucial topics on acute low back pain guideline. Featuring insights from Dr. Jessica Oswald, MD, MPH and Dr. Devin Kansagara, MD, FACP, this episode focuses on the implications of FDA-funded guidelines, co-sponsored by the American Academy of Pain Medicine. This expert panel discusses the nuances of managing acute low back pain, emphasizing evidence-based practices to improve patient care.

Throughout the episode, Dr. Oswald and Dr. Kansagara explore the guidelines' perspectives on imaging, opioids, and alternative therapies. Discussing the common tendency to order imaging tests for low back pain, the conversation shifts to effective patient communication and strategies for reducing unnecessary imaging. They also address opioid use, highlighting its role as a third-line option and discussing the importance of evaluating individual patient needs to optimize function without escalating risks. The episode also emphasizes non-pharmacological interventions, such as early physical therapy, and overcoming challenges related to access bottlenecks. 

Key Takeaways

• Guideline Applicability: Emphasizing the acute stage, the guidelines apply to pain lasting less than six weeks.
• Imaging Insights: Many clinicians still rely heavily on imaging for acute low back pain despite evidence showing limited benefit. Patient communication is crucial in managing expectations.
• Opioid Recommendations: Reserved as a third-line treatment, opioids are not usually recommended for acute low back pain due to risks outweighing benefits in most cases.
• Non-Pharmacological Therapies: Early engagement in physical therapy and alternative therapies can enhance long-term recovery, highlighting the importance of patient education and movement.
• Epidural Injections and Controversies: The discussion points out the limited evidence for epidural steroid injections, prompting nuances in clinical decision-making amid evidence shortages.

Views expressed by our hosts and guests are their own and do not necessarily reflect those of the hosts, their institutions, or the American Academy of Pain Medicine.

About our Hosts

• Dr. Sudheer Potru, DO, FASA, FASAM, Former Associate Professor of Anesthesiology at Emory University School of Medicine and Medical Director of the Complex Pain and High-Risk Opioid Clinic at the Atlanta VA Healthcare System. Dr. Potru is board certified in pain medicine, anesthesiology, and addiction medicine. His academic portfolio includes leadership roles with AAPM, ASRA Pain Medicine, and the American Society of Anesthesiologists. A recipient of the 2023 ASRA Excellence in Education Award, he is widely regarded for his national lectures and educational scholarship on opioid stewardship and interdisciplinary pain management.
• Dr. Mustafa Broachwala, MD, a nationally recognized, double board-certified physician in Physical Medicine and Rehabilitation and Pain Medicine, specializing in the comprehensive, evidence-based treatment of acute and chronic pain conditions. He completed advanced training at world-renowned institutions including Johns Hopkins Hospital and the University of California, San Diego, where he developed expertise in multidisciplinary and interventional pain management.