Multimodal Treatment Approach to Chronic Low Back Pain


The panelists address the tension between patients with chronic low back pain who want one single pill to erase their symptoms and physicians who take the more effective multimodal approach, which irritates those patients.

“We don’t have one single drug that will give you 100 percent efficacy, and, therefore, as clinicians, we’re forced into this multimodal approach,” Jeffrey A. Gudin, MD, expresses. “So, when patients come up and say, ‘What drug can I take for my back pain?’ I usually say, ‘There’s not one single drug that’s effective for all kinds of pain, and it varies from patient to patient, which is why we need to go through these multi-drug trials.’”

Though moderator Peter Salgo, MD, notes that answer is “so irritating to patients,” Joseph Pergolizzi, MD, explains “part of it is that pain is perception, and that’s why we do not have one golden bullet.”

“We’re a little smarter and we’re not just blanketly treating back pain. I think we are addressing it based on severity upon initial presentation, and then particularly with moderate to severe chronic low back pain, we’re making sure that whether or not there is a neuropathic component to that and we’re trying to become more mechanistic driven.”

But Salgo emphasizes that patients just “want a pill,” to which Pergolizzi responds that chronic low back pain is “very different than other chronic disease management states” that immediately assign patient educators, such as diabetes.

“The moment you have that diagnosis, someone is going to come and there’s appropriate funding towards coming to educate you how to eat properly, how to monitor your glucose, how to do these other things. That’s missing … when you have chronic pain,” Pergolizzi. “Instead, we have a lot of education on the potential, let’s say, negative side of treating patients with certain types of medications.”

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