Several nonpharmacologic therapies associated with benefits for chronic low back pain

1. In this systematic review, researchers found associations with short-term pain benefits on a small to moderate level for exercise, psychological therapies, multidisciplinary rehabilitation, acupuncture, massage, and spinal manipulation as treatment for chronic low back pain.

2. In comparison to pain, effects on function were usually smaller or not noted.

Evidence Rating Level: 1 (Excellent)                                                        

Study Rundown: Low back pain is a widespread issue linked to more disability worldwide than any other ailment. In this study, the authors systematically reviewed current evidence for nonpharmacologic treatment of acute or chronic low back pain of nonradicular or radicular type. Researchers found evidence demonstrating that exercise, multidisciplinary rehabilitation, spinal manipulation, psychological therapies, acupuncture, and massage are effective for chronic low back pain. There was some limited evidence demonstrating modest levels of effectiveness for acupuncture as a treatment for acute low back pain. Pain reduction was small to moderate and tended to be short term. Overall, benefits for function were smaller than those for pain. No serious harms were observed for any of the reviewed therapies. This updated review supports previous findings that exercise, multidisciplinary rehabilitation, spinal manipulation, psychological therapies, acupuncture, and massage may be effective treatments for patients with chronic low back pain.

Strengths of this study include the addition of therapies not previously addressed (tai chi and mindfulness-based stress reduction therapies) as well as more recent evidence since the time of the 2007 American College of Physicians guidelines. Limitations of this study include restriction to English-language studies, the inability to eliminate placebo effects, treatment technique heterogeneity, and exclusion of some nonpharmacologic interventions.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline

In-Depth [systematic review]: In this study, researchers searched Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and reference lists to find 114 publications meeting the inclusion criteria. Researchers analyzed the following therapies: exercise (122 trials), tai chi (2 fair-quality trials), yoga (14 trials), mindfulness-based stress reduction (3 trials), psychological therapies (32 trials), multidisciplinary rehabilitation (44 trials), acupuncture (49 trials), massage (26 trials), and spinal manipulation (61 trials). Researchers found short-term (<3 months) pain benefits on a small (5-10 points on a visual analogue scale ranging from 0-100) to moderate level (10-20 points) for exercise, psychological therapies, multidisciplinary rehabilitation, acupuncture, massage, and spinal manipulation as a treatment method for chronic low back pain. In comparison to pain, effects on function were usually smaller or not noted. The evidence was largely for chronic low back pain. Additional research is needed to detect nonpharmacologic treatments that may be effective for radicular and acute low back pain.

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