Only around one in ten non-surgical and non-interventional treatments for lower back pain are effective, a research study has suggested.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be effective for acute low back pain. Exercise, spinal manipulation therapy, and some medications, such as antidepressants and TRPV1 agonists, may also be effective for chronic low back pain.
However, researchers have claimed that treatments that do work are only marginally more effective than a placebo.
The findings, published in BMJ Evidence Based Medicine, highlight the need for more clinical trials to test the efficacy of non-surgical and non-interventional treatments for low back pain.
Low back can be debilitating, often leading to impaired movement and social withdrawal. In up to 90 per cent of cases, the pain has no identifiable cause and often the efficacy of treatment options is unclear.
The researchers conducted a meta-analysis of randomised placebo-controlled trials to examine which non-surgical and non-invasive lower back pain treatments were most effective compared to placebo. Treatments included pharmacological, such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants, and non-pharmacological, such as exercise, massage, and spinal manipulation. The study included 301 trials investigating 56 treatments or treatment combinations, including studies from North America, South America, Africa, Asia, Australia, and Europe.
The most common interventions were NSAIDs (27 trials), opioids (26 trials), laser and light therapy (25), acupuncture (24), and gentle mobilisation therapy (19 trials).
The researchers found that NSAIDs were the only effective for acute low back pain, and exercise, spinal manipulative therapy, taping, antidepressants and TRPV1 agonists could be effective for chronic low back pain. However, the benefits of all treatments are small.
The researchers used the GRADE system to evaluate the quality of evidence and found that most treatments had low or very low certainty in their effectiveness. Of the 69 treatment comparisons included in the trials, the certainty of the evidence was moderate for 11, low for 25, and very low for 33, indicating more high-quality research is needed to confirm the benefits of these treatments.
Exercise, steroid injections, and paracetamol were found to be ineffective in treating low back pain and anaesthetics such as Lidocaine and antibiotics were also found to be ineffective for chronic low back pain.
The evidence of efficacy for ten non-pharmacological and ten pharmacological treatments for acute low back pain was inconclusive. For chronic back pain, there was also a lack of evidence to support the use of a wide range of non-pharmacological treatments, including acupuncture, massage, osteopathy, and TENS, and for pharmacological treatments, including antidepressants combined with paracetamol, complementary medicines, bisphosphonates, and muscle relaxants.
The researchers said: ‘Our review did not find reliable evidence of large effects for any of the included treatments, which is consistent with clinical guidelines and our previous review. While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time.’
They added: ‘There is a clear need for large, high-quality, placebo-controlled trials to reduce uncertainty in efficacy estimates for many non-surgical and non-interventional treatments.’
