Researchers have reviewed non-drug and non-surgical treatments for low back pain to assess which ones are more likely to reduce pain and improve function. What the review made clear is that more research into effective low back pain treatments is needed.
Most adults will have experienced short-term or acute low back pain (LBP) at least once in their lives. Normally, it resolves after six weeks or so. Unfortunately, for many people, acute LBP doesn’t resolve and becomes a chronic issue. Treatment of acute and chronic LBP depends on whether the pain is specific (has a determinable cause) or non-specific.
While medications are often the first-line treatment for LBP, non-pharmaceutical treatments, such as physical therapy, can help. Now, researchers from the University of New South Wales (UNSW) Sydney and Neuroscience Research Australia (NeuRA) have reviewed non-drug, non-surgical treatments for LBP to determine the most effective ones.
“Low back pain is pain between the lower edge of the ribs and the buttocks and can vary in its nature and severity,” said Professor James McAuley, senior research scientist at NeuRA, director of the Center for Pain IMPACT, and the study’s senior author. “While not many non-drug and non-surgical treatments are promoted, we wanted to see what the evidence actually showed regarding effectiveness and presence of adverse effects.”
The researchers undertook a Cochrane review, which seeks to answer a specific research question by bringing together and evaluating evidence from human studies. It’s considered the pinnacle of evidence-based healthcare. Cochrane reviews are freely available and housed online in the Cochrane Library.
For the present review, the researchers assessed 31 Cochrane reviews of 644 randomized controlled trials that included 97,183 adult participants with LBP without a specific cause. The researchers categorized treatments according to pain duration in keeping with the World Health Organization’s (WHO) definitions and compared the effectiveness of non-drug/non-surgical interventions to placebo/sham treatments or no treatment/usual care at follow-up less than or equal to three months.
It’s important to know that Cochrane reviews intentionally use terms like “probably” and “may.” They’re based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, a tool used to assess evidence quality and strength-of-evidence recommendations produced in synthesis reports. Where “probably” is used, the reviewers think the evidence is of moderate quality; that is, the true effect is probably close to the estimated effect.
“We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews,” the researchers said.
Acute low back pain lasting less than six weeks
- Advice to stay active probably reduces LBP and improves function compared to advice to rest in bed.
Subacute low back pain lasting from six to 12 weeks
- Compared to usual treatment, multidisciplinary therapies probably reduce LBP. The researchers defined “multidisciplinary therapy” as including a physical intervention and at least one other element that was either psychological, social, or occupational.
- Spinal manipulation probably did not improve function compared to a placebo or sham treatment.
Chronic low back pain lasting longer than 12 weeks
- Acupuncture probably reduces pain and improves function compared to placebo and no treatment or usual care.
- Likewise, exercise therapies (which includes stretching, strengthening, general resistance training, aerobic exercise, Pilates and yoga, tai chi, and water-based exercises).
- Multidisciplinary therapy probably reduces pain and improves function compared to usual care.
- Compared to usual care, psychological therapies probably reduce pain but have no effect on function. Traction probably doesn’t reduce pain compared to sham traction.
Of course, one limitation of the study is the researchers’ reduced confidence in some evidence.
“We have reduced confidence in the evidence because we judged that 38% of the reviews did not employ the most rigorous methods available,” they said. “Almost three-quarters of the reviews were published before 2020, meaning that the evidence they contain may be relatively dated. There is a need to update some Cochrane reviews following recommended guidance. Because of the quality of the evidence, we are still uncertain about the benefits or risks of many non-medicine and non-surgical treatments commonly used for low back pain.”
More research is necessary to investigate innovative and cost-effective treatments for LBP and to identify who will benefit from particular non-drug and non-surgical interventions.
The review, entitled “Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews” is available in the Cochrane Library.
Source: NeuRA
