Lower Back Pain: Physical Therapies Over Meds Recommended; Heart Disease Cost to Exceed $1 Trillion by 2035, Warns AHA

New guidelines from the American College of Physicians (ACP) emphasize that doctors should suggest prescription pain medicines only as a last resort after patients try heat treatments, massage, yoga or supervised physical therapy.

The ACP discourages the use of prescription opioid pain meds due to the risk of addiction or overdose. Studies have increasingly cited the success of alternative non-drug therapies for treating lower back pain.

Lower back pain is one of the most commonly cited reasons adults see their doctors. One in four U.S. adults report having lower back pain, which normally eases or goes away in a few days or weeks without treatment, according to the guidelines. The guidelines published in the Annals of Internal Medicine, represent a change from previous medication-first guidelines for treating lower back pain.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” said Nitin S. Damle, M.D., and president of the ACP, in a statement. “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.”

People typically suffer from three degrees or classifications of back pain, the guidelines say. Acute back pain that lasts less than four weeks; subacute back pain lasts four to 12 weeks; and chronic back pain can persist for more than four months.

For those with acute or subacute back pain, relief should be found in heat therapy, spinal manipulation, massage, exercise, physical therapy or yoga-type routines, according to the guidelines.

“For the treatment of chronic low back pain, physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another,” Damle said in the statement. “Physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training.”

If non-drug therapies don’t work, back pain patients should use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or muscle relaxants prescribed by a doctor. Acetaminophen and steroids are not recommended for low back pain, according to the guidelines.

Here is the full list of recommendations from the ACP, according to degree or classification of back pain.

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Heart Disease Cost to Exceed $1 Trillion by 2035, Warns AHA

Over the next two decades, the number of Americans with heart disease will surge to 131.2 million – representing 45 percent of the total U.S. population – with healthcare costs expected to reach $1.1 trillion, according to a new study released by the American Heart Association (AHA).

That trillion-dollar estimate is double the current $555 billion costs related to heart disease. The new projections from the AHA are an update of estimates made by the association in 2011 that projected about 100 million Americans would suffer from cardiovascular disease by 2030.

“Unfortunately, that predication came true in 2015 – almost 15 years sooner than anticipated,” a statement from the AHA says.

In 2015, about 41.5 percent of the U.S. population had at least one heart-related health problem, said the AHA’s report, Cardiovascular Disease: A Costly Burden for America.

“While we have made tremendous progress in fighting cardiovascular disease, recently reported death rates and these projections reinforce that now is not the time to relax,” warns AHA President Steven Houser. “We must continue to be vigilant, because if these projections become reality, a serious health and economic crisis is on the horizon.”

This latest study projects that by 2035, 123.2 million Americans will have high blood pressure; 24 million will be diagnosed with coronary heart disease (a common term for the buildup of plaque in the heart’s arteries); 11.2 million will have suffered a stroke; and 7.2 million Americans will be diagnosed with atrial fibrillation, or an abnormal heartbeat. All of these are considered major risk factors for heart disease, as are high cholesterol and diabetes. Smoking and being obese or overweight are also risk factors.

Other key findings from the AHA:

• By age 45, your heart disease risk is 50 percent, at 65 it jumps to 80 percent;
• African-Americans will have the highest rates of heart disease by 2035, followed by Hispanics;
• Men will suffer from heart disease at a greater rate than women between now and 2035

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