The Osher Center for Integrative Medicine at Vanderbilt offers most of the treatments in the new guidelines for back pain recently recommended by the American College of Physicians, but misconceptions about those treatments remain a barrier to care.
Patients may picture inaccurate images when a provider prescribes integrative medicine practices including yoga or mindfulness instead of over-the-counter pain medications or opioids, said Linda Manning, Ph.D., interim director of the Osher Center.
The new guidelines published recently in Annals of Internal Medicine recommend superficial heat, massage and acupuncture for episodes of acute low back pain. The recommendations for chronic low back pain include exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi and yoga.
Pain medications should be considered if these practices fail to provide relief, but NSAIDs — not opioids — should be the first line therapy. Opioids should be the last option, according to the guidelines.
Manning stressed that Osher provides pain treatments carefully tailored to each patient’s needs.
“First, a back pain patient would see one of our providers, either a physician or a nurse practitioner, who would help that patient get a sense of what is leading to the back pain and make a plan that might include acupuncture and/or yoga and/or massage,” she said.
Therapeutic yoga is appropriate for patients with medical conditions and pain, she said, unlike some classes focused on fitness. And the benefits of mindfulness and meditation don’t require assuming a lotus position on the floor, she said. Those benefits can also be gained sitting in a chair or lying down.
“We usually start our mindfulness classes by teaching people to sit and focus on their breath, to notice what their breath feels like in their body, the body sensations of breathing,” said psychotherapist Michelle Pearce, D.Min., MSN, R.N. “And when their minds wander, to notice that, to acknowledge that and gently bring it back. We generally consider that the beginning process of mental training, learning to focus on one thing.”
The clinical staff includes a physician, four nurse practitioners, two health psychologists, a psychotherapist, an acupuncturist, a massage therapist, two physical therapists, three yoga instructors and one Tai Chi and Qigong instructor.
Treatments for back pain include massage, exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercises, progressive relaxation, electromyography biofeedback and cognitive behavioral therapy. For patients with chronic low back pain who don’t respond to nonpharmacologic treatments, the center’s clinicians may prescribe non-opioid medications as second-line therapy.
