The American College of Physicians says to use natural and alternative therapies first

By Sumathi Reddy

Skip the meds. Lower back pain - one of the most common reasons for a doctor’s visit - is best treated with alternative, natural and psychological therapies, say new guidelines from the American College of Physicians.

Opioids One of the most commonly prescribed medications for pain relief and a source of increasing addiction and death - should only be considered for chronic back pain when other alternatives - natural and prescription - don’t work, say the guidelines published Monday in the Annals of Internal Medicine.

Even acetaminophen, which includes the brand name Tylenol, is no longer recommended for acute lower back pain relief due to a 2014 study in the journal The Lancet that showed it was no more effective than placebo. "For consumers who need to treat their minor aches and pains due to backache, Tylenol is a short-term treatment option when used as directed," said a spokesperson for Johnson & Johnson Consumer, which manufacturers Tylenol.

The new guidelines could influence how doctors treat patients with complaints of back pain. They are an update from 2007’s and include a review of more than 150 studies. Recommendations were broken down into acute and subacute lower back pain, which is pain lasting less than 12 weeks, and chronic pain, which is pain lasting more than 12 weeks. They don't apply to radicular low back pain, sometimes referred to as sciatica, which is caused by compression of the nerves in the spine and can result in leg pain.

For chronic back pain, the guidelines recommend patients also first try nondrug therapies, such as acupuncture, exercise, rehabilitation therapy and mindfulness-based stress reduction. They also recommend, with less robust data backing them up, yoga, tai chi, motor control exercises, which focus on central core stabilization, and other psychological approaches, such as cognitive behavioral therapy.

The reviews focused on improving pain and function. Psychological conditions such as depression and anxiety are often present in people with lower back pain and may even predispose them to developing it, or the back pain can worsen depression, said Roger Chou, a professor in the department of medical informatics and clinical epidemiology at Oregon Health & Science University and first author on the two reviews done to inform the guidelines.

If such treatments fail to provide relief, the ACP says NSAIDS should be the first medicine that is used. The second line of treatment should be duloxetine - sold under the brand name Cymbalta and commonly used to treat depression and anxiety - or tramadol, an opioid-like narcotic which is less potent than standard opioids such as oxycodone or fentanyl - but can still cause physical dependence.

The guidelines warn that opioids should only be considered an option if the doctor and patient have a discussion about the known risks of the drugs and if used at the lowest possible dose for the shortest period. Because lower back pain is the most common reason non-cancer patients are prescribed opioids, experts believe it is a common gateway to opioid addiction as well as transitioning to heroin, said Steven Atlas, director of practice-based research at Massachusetts General Hospital, who authored an editorial accompanying the guidelines.

About 80% of adults experience low back pain at some point in their lifetimes and it is the most common cause of job-related disability and a leading contributor to missed work days, according to the National Institute of Neurological Disorders and Stroke. Causes of low back pain are varied and include changes in the spine, nerves, muscle or discs in the back and they way they move.

Pain can begin abruptly as a result of an accident or by lifting something heavy. More often, though, it develops over time due to age-related changes of the spine and disc degeneration, according to the NINDS website, part of the National Institutes of Health. NINDS says most back pain occurs between ages 30 and 50. Individuals who gain weight and don’t exercise are at risk, as are those who exercise intensely after long breaks of not exercising. Poor posture or being inactive can also contribute to injuries.

"About one-quarter of U.S. adults have had back pain in the past few months," said Nitin Damle, president of the ACP. "We are advocating for really trying the non-pharmacologic approach initially, especially for acute and subacute back pain." Opioids, even for chronic pain, are "prescribed more often than we would like to see."

Dr. Atlas said many of the non-medication based treatments cited in the study have only moderate-to-low-quality evidence to prove their effectiveness.

"The magnitude of the benefit - for both non-pharmacological treatment and medicines - isn’t particularly strong," said Dr. Atlas. "It’s not like we have big home runs."

by Msgr. Charles Pope

The following post contains some adult content. There is nothing inappropriate, but it does speak frankly to an aspect of sexual desire. Exercise caution if reading it to younger children.

There is a secret, once known and widely shared among women, that the best way to get and hold a man's attention is through modesty. Near nakedness can get a man's attention, but it is modesty that will hold it.

Why is this so? It is because mystery is powerfully attractive. It entices; it draws and holds one in a kind of suspense. At its heart, modesty is a reverence for mystery. It uses mystery to build the very relationship that is meant to unlock its secrets: Holy Matrimony.

Relationships are not built by a mere glance. Modesty helps to hold the glance while the relationship has time to grow and be tested.

Modesty is not prudishness. The word modesty comes from the word mode, which refers to a central tendency of a group of numbers. As such, modesty is a kind of middle ground that does not seek to burden women with excessive coverings but that also considers the needs of others, so as not to inflame passions and lust. True modesty reveals beauty, but also reminds that much more remains hidden and must be reserved only for the deepest relationship of Holy Matrimony.

Sadly, many women today have not been taught this essential feminine virtue. Men are too often treated to a "full disclosure" or to disclosures that leave little to the imagination. This does excite a kind of "animal" attraction in a man, but it cannot usually hold that attention for very long. Why? Because mystery, once disclosed, is no longer mystery, and its attractive power vanishes quickly. Soon enough, a man who is not attached to a woman for deeper reasons loses interest and starts to be drawn to other women, whose mystery still attracts because it has not been uncovered.

Many men are not even consciously aware that this is why they have lost interest; they do not intend to be crass. But at the level of desire, mystery is important. Once the key has been turned and the mystery unlocked, a powerful card has been played.

Women used to instinctively and collectively know this. They used modesty to hold the man's attention, build the relationship, summon his proposal of marriage, and then draw him to the marriage bed - not to the back seat of a car or an apartment couch. In the context of a more fully formed relationship the fuller mystery of her was finally revealed and shared. Children usually came quickly in those days and this, too, helped to hold the man fast. Though her mysteries had been revealed, there was now more to keep the man's attention. For by now, after courtship and engagement, he now knew her more richly in the depth of her person. They had shared memories and become part of each other's extended families. And even more, their own children were now here, or at least on the way.

The mystery kept secret by modesty was now revealed, but the ties that bind were now operative and filled the role that modesty had assisted in bringing about. And most women of previous generations also knew that even after marriage modesty still had some role, for her modest attire and demeanor still could draw his glance somehow.

Yes, modesty is a great feminine secret, once known by most women. Now, though, many have foolishly cast it aside.

I pray that many will once again discover modesty's paradoxical draw. While immodesty may attract a man's quick, animal attention, only modesty can really hold his attention and root it in something higher and better than animal desire. Believe it or not, men have rational souls too! Higher and better motives still work and attract men. Modesty is both powerful and attractive. Here's to a great "secret weapon"!

by Dr. James Dobson

I want you to be wise about what is good.
- Romans 16:19

Josh was so excited. The day had finally arrived. After lunch, his father was taking him to the circus! Then the phone rang. As Josh listened to his father speak, his heart sank. Something about urgent business that required his father's attention downtown. With tears in his eyes, Josh got up from the kitchen table and began walking slowly toward his room. Then he heard his father say, "No, I won't be down. It will have to wait." Almost in disbelief, Josh hurried back to the table and saw his mother smiling at his father. "The circus will come back, you know," she said. "I know," his father answered. "But childhood won't."

We do have choices in how we spend our days. Yes, there are consequences if we put off an assignment at work or postpone cleaning the house. But when the alternative is taking time for your son or daughter, what is the better choice? After all, when Jesus asked two fishermen named Peter and Andrew to "Come, follow me" (Mark 1:17), did they respond with, "Not now, Jesus, we have important work to do"?

We encourage you to weigh your options carefully as you plan your schedule. Sometimes an afternoon under the big top is the best appointment of all.

Before you say good night…

Do you ever appear to value your work over the kids?

What is God saying to you about the amount of time you spend with your children?

How can you increase your time together as a family?

O Lord of time and eternity, You know very well how fleeting is the opportunity to encourage our children. Open our eyes so that we might cherish such moments and not let them slip away. In Jesus' name, amen.

by Wes Hopper

"I always remind myself that there is no way to happiness. Happiness is the way. And happiness is an inside job. If you find serenity and happiness, people may be jealous. Be happy anyway." Wayne Dyer

I love the way that Dyer, in this quote, gives us permission to be happy even when we're surrounded by people in misery clamoring for our attention. Although he doesn't say so, he most likely recognizes that people who spend their lives feeling miserable like nothing better than to spread the misery around.

So his simple command to be happy anyway is a rebuke to the folks who would have us join their misery. I think in all due fairness that we should invite the miserable people in our life to join us in being happy! Because the fact is that how we, and everyone, respond to circumstances is up to us.

I think that as part of our daily routine we should all take a few minutes in meditation every morning and review the good things that have happened in our life. Most of us have spent most of our thinking time reviewing the problems and disasters we've faced, so reviewing the good things should be a welcome relief.

by Dr. Joe McKeever

Disclaimer: I'm still a learner, and most definitely not an expert on praying.

1. The only real mistake we can make in prayer is in not praying.

If we pray earnestly, almost anything we do is better than not praying. After all, no father rejects the child's plea because she did not use the right words or form. He welcomes his child into his arms.

Someone has said, "Nothing never happens when we pray."

2. No matter how much you pray, you will never be completely satisfied with your prayer life.

You will always feel the goal is out there beyond you somewhere. We must work against perfectionism, that mental disease that convinces us because we're not doing something perfectly, that we should stop it altogether. No matter how ineffective you think your prayers are, believe that they matter to God and keep on praying.

3. The Holy Spirit helps us in our prayer.

Romans 8:26 assures us "He helps us in our weakness because we do not know how to pray." The Greek word translated "helps" is a compound Greek verb "synantilambanomai." The "syn" means "together, with us." The "anti" means "opposite to, in front of." And the "lambanomai" is a form of the verb "to lift." Together they tell us the Holy Spirit gets on the other end of our task, opposite to us, and together with us lifts the burden. He does not do this in our place, but works with us.

4. Keep on praying.

Persistence in prayer is taught so many times in Scripture. My favorite is blind Bartimaeus in Luke 18. Let nothing stop you from praying. Not your own inadequacy (of which there is much), your own needs (which can be overwhelming), not your fears (which never tire of assaulting you), and most definitely not other people (discouragement is all around us). Just keep at it.

5. Our emotions and feelings are irrelevant to effective praying.

We need to rescue our prayer life from bondage to our emotions. You know, "I don't feel like my prayers go beyond the ceiling," or "I don't feel like praying today." When you turn to the Father in prayer, how you feel has nothing to do with anything. Pray anyway.

6. Heaven places the same value on our prayers that we do.

If it matters to us, it matters to our Heavenly Father. The widow's mite did not mean much to anyone else in the Temple that day, but because it mattered a great deal to her, it was precious to the Father. This principle holds true for our prayers, our offerings, and anything else we give to the Lord: when it arrives in Heaven, it carries the same value there we placed on it here.

7. Throw away your clock.

Jesus said it's the heathen who think they will be heard for their much speaking. The goal in our prayertime is to be real, to touch Heaven, and not to log so much time. Think how insulted your sweetheart would be if you brought along a clock on your next visit, and you kept looking at it to see how much time had gone by so you could feel good about the investment you were making in the relationship. How much time you spend in prayer has little to do with anything. This assumes, of course, that you are spending some quality time with Him each day in prayer.

8. It's not necessary to know the will of God in order to ask for something.

Go ahead and ask for healing, for that new job, for this blessing, or that condition to change. What if it's not the will of God? Then, friend, He won't do it.

Do not think you are tying God's hands by your prayers. That's why Jesus ended His prayer in Gethsemane with "Not my will, but Thy will be done." He taught us to pray "Thy will be done on earth as it is in Heaven."

My job is to ask. It's the Father's place to sort things out and decide what He wishes to answer and grant.

9. There is a mystery involved whenever we come into the presence of God.

We are kneeling before the Almighty Sovereign God, Lord of the universe. Be quiet. Be still. Get alone with Him. Humble yourself. Wait on Him. Respect Him as having sense and quit insulting Him with your pet memorized phrases. Tell Him the truth, what you've been up to and what you're thinking now. Tell Him what blesses you about Him, and what areas of your life you need particular help with.

Jesus said He already knows our needs before we ask, but He likes to see if we have figured things out too. So, go ahead and make your requests to Him.

Whatever answer comes, accept that as His will, at least for the time being. And keep on praying.

10. Always keep paper and pen handy when you are praying.

My experience is that when you come into the Father's presence in prayer, He will frequently call your attention to something He wants you to know or do. He may tell you someone to see, something to do, someone to call, something to forgive, a verse to look up, a text to remember, a debt to pay, or a neighbor to help. Write it down. Then, go back to your prayer. Expect to receive from Him every time you turn to Him in prayer.

When I was a kid on the Alabama farm, times were hard and surprises were rare. But we were always glad when our uncle Johnny Chadwick drove up from Birmingham. He was a police officer with the city and was forever meeting interesting people, getting challenging ideas, and having things given to him. He would bring up day old cakes and pies from bakeries. He once brought me an old used bicycle, the first I'd ever owned. Once he arrived with a truckload of calves which it became my assignment to feed before and after school. He never came empty-handed. We were always eager to meet Uncle Johnny.