+AA
Fr
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

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

Condition

Recommendations

Evidence (effect size)

Low back pain for up to 12 weeks (acute or subacute)

First choice for treatment in most patients should be

  • superficial heat; or
  • massage, acupuncture, or spinal manipulation.

Heat wrap improved pain and function (moderate).

Massage improved pain and function at 1 week (moderate).

Acupuncture improved pain (small).

Spinal manipulation improved function (small).

Low back pain for more than 12 weeks (chronic)

Treatment should begin with non-drug treatment, including

  • exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction; or
  • yoga, tai chi, progressive relaxation, motor control exercise, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive-behavioral therapy, or spinal manipulation.

Exercise improved pain and function (small).

Multidisciplinary rehabilitation improved pain at less than 3 months (moderate) or longer (small).

Acupuncture improved pain and function (moderate).

Mindfulness-based stress reduction improved pain and function (small).

Yoga improved pain and function at 24 weeks (moderate).

Tai chi improved pain (moderate) and function (small).

Progressive relaxation improved pain and function (moderate).

Motor control exercise improved pain (moderate) and function (small).

Electromyography feedback training improved pain (moderate).

Low-level laser therapy improved pain and function (small).

Operant therapy improved pain (small).

Cognitive-behavioral therapy improved pain (moderate).

Spinal manipulation improved pain (small).

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

 



Related Topics


Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Several non-invasive treatments work for neck pain

    Institute for Work & Health
    Educational videos, exercise, and neck mobilization were more beneficial for treating neck pain or whip lash than ultrasound or electrical stimulation. Laser therapy, exercise and massage or acupuncture may help with chronic pain. Hard or soft collars did not work.
  • Some herbal drugs may ease back pain in short term

    Institute for Work & Health
    Some alternative herbal medicines may help to relieve back pain. Devil's Claw, Willow Bark and cayenne may help reduce pain in the short term. However, there is no evidence that these substances are safe or useful in the long-term.
  • Exercise for low back pain

    Berkeley Wellness
    Exercise can help prevent lower back pain, especially when combined with education about back care.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use