Choosing Wisely Targets Low Back Pain Remedies, Other Unnecessary Treatments

Edited by William E. Chavey, MD, MS

Three medical associations have recently issued recommendations on practices that should be questioned or avoided as part of the Choosing Wisely campaign, which aims to reduce unnecessary tests and procedures.

Among the 15 recommendations:

• The American Chiropractic Association says that lumbar supports or braces shouldn’t be prescribed for long-term management of low back pain. The group also recommends avoiding long-term use of passive or palliative physical therapies (e.g., heat, cold, ultrasound) for low back pain unless they help increase patients’ activity levels.
• The American Podiatric Medical Association recommends against ordering magnetic resonance imaging in suspected cases of Achilles tendon rupture, as physical exam findings should be sufficient for diagnosis.

The American Association of Neuromuscular & Electrodiagnostic Medicine recommends against using vitamin B supplements to treat polyneuropathy or neuropathic pain unless the patient is deficient. In addition, opioids and narcotics should not be first-line treatments for neuropathic pain.