In people with acute or chronic low back pain, some non-drug treatments can provide small to moderate improvement in pain and functioning

Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166:493-505.

Review question

In people with low back pain, do non-drug treatments improve pain and functioning?

Background

Low back pain is very common and may be experienced as dull or sharp and can be specific to one area or over a larger area, usually between the ribs and legs. It may also cause leg symptoms. There are many causes of low back pain, including injury or strain, aging, illness, fractures, and problems existing since birth.

Low back pain often lasts less than 4 weeks (acute), though it may be subacute (4 to 12 weeks) or chronic (lasting longer than 12 weeks).

Treatment of low back pain is difficult and often not very effective at improving pain or functioning.

How the review was done

The researchers did a systematic review based on studies available up to November 2016.

They found more than 120 randomized controlled trials.

The key features of the studies were:

• participants were adults who had acute, subacute, or chronic low back pain not caused by cancer, neurologic deficits, infection, fracture, or trauma;
• treatments were non-drug treatments, including exercise, massage, acupuncture, spinal manipulation, psychological treatment, tai chi, mindfulness-based stress reduction, yoga, and multidisciplinary rehabilitation; and
• treatments were compared with usual care, sham (pretend treatments), waiting for treatment, or other non-drug treatments.

What the researchers found

Based on the results of this review, the American College of Physicians made 2 strong recommendations (the benefits of treatment clearly outweigh the risk or burden of treatment).

The first choice for treatment of acute or subacute low back pain in most adults should be non-drug options such as superficial heat, massage, acupuncture, or spinal manipulation for small to moderate improvements.

Treatment for chronic back pain should begin with non-drug treatments, including exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, yoga, tai chi, progressive relaxation, motor control exercise, electromyography biofeedback, low-level laser therapy, operant therapy (behavioral therapy involving a reward system), cognitive-behavioral therapy (psychological treatment that helps patients to change their emotional and behavioral reactions), or spinal manipulation for small to moderate improvements.

Conclusion

In people with acute or chronic low back pain, some non-drug treatments can provide small to moderate improvements pain and functioning.

Strong recommendations* from the American College of Physicians for non-drug treatment in adults with low back pain

*The benefits of treatment clearly outweigh the risk or burden of treatment.