Introduction to Low Back Pain
Low back pain (LBP) is a common issue that affects most adults at some point in their lives. It is characterized by pain between the lower edge of the ribs and the buttocks and can vary in its nature and severity. While medications are often the first-line treatment for LBP, non-pharmaceutical treatments, such as physical therapy, can also be effective. 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.
Understanding the Review
The researchers undertook a Cochrane review, which seeks to answer a specific research question by bringing together and evaluating evidence from human studies. They assessed 31 Cochrane reviews of 644 randomized controlled trials that included 97,183 adult participants with LBP without a specific cause. The treatments were categorized according to pain duration, following the World Health Organization’s (WHO) definitions.
Findings for Acute Low Back Pain
Acute Low Back Pain Lasting Less Than Six Weeks
For acute back pain, staying active was found to be better than resting in bed. Advice to stay active probably reduces LBP and improves function compared to advice to rest in bed. This suggests that individuals with acute LBP should prioritize staying active and avoiding prolonged periods of rest.
Findings for Subacute and Chronic Low Back Pain
Subacute Low Back Pain Lasting from Six to 12 Weeks
A multidisciplinary approach was found to be better than the usual treatment for subacute back pain. Multidisciplinary therapies, which include a physical intervention and at least one other element that is either psychological, social, or occupational, probably reduce LBP. However, spinal manipulation probably did not improve function compared to a placebo or sham treatment.
Chronic Low Back Pain Lasting Longer Than 12 Weeks
For chronic LBP, several treatments were found to be effective. Acupuncture probably reduces pain and improves function compared to placebo and no treatment or usual care. Exercise therapies, including stretching, strengthening, general resistance training, aerobic exercise, Pilates, yoga, tai chi, and water-based exercises, also probably reduce pain and improve function. Multidisciplinary therapy probably reduces pain and improves function compared to usual care. Psychological therapies probably reduce pain but have no effect on function.
Limitations and Future Research
One limitation of the study is the researchers’ reduced confidence in some evidence. They judged that 38% of the reviews did not employ the most rigorous methods available, and 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, the researchers are still uncertain about the benefits or risks of many non-medicine and non-surgical treatments commonly used for low back pain.
Conclusion
In conclusion, while some non-drug and non-surgical treatments for LBP have been found to be effective, more research is necessary to investigate innovative and cost-effective treatments. The review highlights the need for updated and rigorous research to identify who will benefit from particular non-drug and non-surgical interventions. By prioritizing high-quality research, healthcare professionals can provide more effective treatments for individuals with LBP, improving their quality of life and reducing the burden of this common condition.
