GPs Urge Robust Research on Back Pain Treatments

Doctors’ leaders have called for more research into the effectiveness of back pain treatments after a study found that only about 10% of common non-surgical and non-interventional treatments are likely to provide relief. 

The study, published in BMJ Evidence-Based Medicine, found that many studies were of poor quality and included limited numbers of participants.

Professor Kamila Hawthorne, chair of the Royal College of General Practitioners (RCGP), said doctors “want to be confident that the interventions we recommend or prescribe are working”.

Limited Evidence for Common Interventions

The analysis of available research, led by Australian academics, reviewed 301 trials conducted in 44 countries. It examined 56 treatments, or treatment combinations, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, laser and light therapy, acupuncture, and manual therapy.

Of the trials, 52 focused on acute low back pain, 228 on chronic low back pain, and 21 included both types.

The study found that for acute low back pain, only NSAIDs had moderate-certainty evidence of efficacy. For chronic low back pain, exercise, spinal manipulative therapy, taping, antidepressants, and transient receptor potential vanilloid 1 (TRPV1) agonists were effective. Even then, “effect sizes were small and of moderate certainty”, underlined the authors. They emphasised that “evidence is inconclusive for remaining treatments due to small samples, imprecision, or low and very low certainty evidence”. 

The researchers also noted that the pain relief provided by these treatments was only “marginally better” than placebo. 

The study emphasised the need for large, high-quality, placebo-controlled trials to reduce uncertainty in efficacy estimates for many non-surgical and non-interventional treatments. They concluded that, “While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time.”

“Back pain and the effectiveness of treatments for it, is an area that needs more research,” commented Hawthorne in a statement. 

Current Guidance on Treatment

Non-surgical and non-invasive approaches are recommended as the initial treatment approach for low back pain. 

The National Institute for Health and Care Excellence (NICE) recommends oral non-NSAIDs, but not paracetamol alone, for managing low back pain.It also suggests manual therapy – such as spinal manipulation or massage – but only alongside exercise and, if necessary, psychological therapy. NICE does not recommend acupuncture or transcutaneous electrical nerve stimulation (TENS) for managing back pain. 

“Back pain is complex and often stems from multiple factors, including inactivity, stress, smoking, and obesity,” said Ash James, director of practice and development at the Chartered Society of Physiotherapy. “That’s why physiotherapy takes a tailored, multi-faceted approach, helping people stay active, manage stress, and address lifestyle factors for long-term health,” he explained to Medscape News UK.

“Interventions need also to be varied and often combined to meet individual needs, so it’s not surprising that a study that looks at treatments in isolation found little impact,” James pointed out. “Many interventions in this study focus on short-term relief, which can help, but may not address the root cause,” he added.

Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written three books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.