What Works for Low Back Pain? New Study Suggests Not Much

TOPLINE:

Most nonsurgical and noninterventional treatments for low back pain failed to outperform placebo in a new systematic review and meta-analysis, with just 10% showing only modest pain relief.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis using randomized placebo-controlled trials of nonsurgical and noninterventional treatments for adults with nonspecific low back pain. They searched four databases and the Cochrane Central Register of Controlled Trials up to April 2023.
• 301 trials were included, providing data on 56 different treatments or treatment combinations.
• The analysis focused on pain intensity outcomes at first assessment posttreatment. Treatments were categorized according to back pain duration (acute, < 12 weeks; chronic, ≥ 12 weeks).
• Risk of bias was estimated using the PEDro scale, and certainty of evidence was evaluated using the Grading of Recommendations Assessment approach.

TAKEAWAY:

• For acute low back pain, only nonsteroidal anti-inflammatory drugs showed efficacy with moderate-certainty evidence compared with placebo.
• For chronic low back pain, five treatments showed efficacy with moderate-certainty evidence: exercise, spinal manipulative therapy, taping, antidepressants, and transient receptor potential vanilloid 1 agonists.
• Three treatments for acute low back pain (exercise, glucocorticoid injections, and paracetamol) and two for chronic low back pain (antibiotics and anesthetics) showed no efficacy with moderate-certainty evidence.
• Overall, 20 treatments for acute low back pain and 38 for chronic low back pain had inconclusive evidence for efficacy because of low- to very low–certainty data.

IN PRACTICE:

“Most nonsurgical and noninterventional treatments for low back pain were not efficacious,” the investigators wrote.

“Further high-quality, placebo-controlled trials to reduce uncertainty in remaining efficacy estimates are warranted as well as greater consideration for the design of placebos” of many treatments, they added.

SOURCE:

The study was led by Aidan G. Cashin, PhD, Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, Australia. It was published online on March 18 in BMJ Evidence-Based Medicine.

LIMITATIONS:

The study was limited by variability in placebo definitions across trials, grouping of similar treatments regardless of administration route, and exclusion of unpublished trials. Certainty in findings was limited by small sample sizes, inconsistent results, and heterogeneous placebo quality.

DISCLOSURES:

The investigators reported receiving partial funding support from institutional awards and national health research grants, With full details provided in the original article. No relevant conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.