A new comprehensive review published in BMJ Evidence-Based Medicine found that only about 10 percent of common nonsurgical treatments for lower back pain were effective, providing only "small analgesic effects beyond placebo," according to The Guardian. The study analyzed data from 301 trials investigating 56 different treatments or treatment combinations, carried out in 44 countries across Africa, North America, South America, Asia, Australia, and Europe.
"The results of the review help clarify which treatments have a specific effect and are worth considering," said lead author Aidan Cashin, a researcher at the Pain Management Centre at the University of New South Wales in Sydney, Australia. The analysis revealed that for acute lower back pain, only non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and celecoxib were proven effective, with no non-pharmacological treatments showing efficacy. However, the effects of these treatments were small compared to placebo.
For chronic low back pain, effective treatments included physical exercises, spinal manipulation, taping, and rehabilitative treatments. Exercise reduces lumbar pain by 20% without losing effect over time, according to Medical Xpress. The review found that many popular treatments for acute low back pain, including exercise, steroid injections, and paracetamol, were shown to be ineffective, while anesthetics and antibiotics were not effective for chronic pain.
The evidence was inconclusive for a wide range of treatments for both acute and chronic low back pain, including 22 non-pharmacological treatments such as acupuncture, massage, osteopathy, and transcutaneous electrical nerve stimulation (TENS), as well as 16 pharmacological treatments. "The effectiveness of most treatments is uncertain. Our review found no reliable evidence for large effects for any of the included treatments," the researchers stated, as reported by Discover Magazine.
Low back pain is common and debilitating, with 80-90% of cases categorized as non-specific because there is no immediately identifiable cause. More than 600 million people worldwide suffer from low back pain. The National Health Service (NHS) in England advises lower back pain sufferers to "try doing some exercises and stretching to relieve back pain" and to continue with their normal activities as far as possible, according to The Guardian.
The researchers emphasized the need for larger, high-quality, placebo-controlled trials to reduce uncertainty regarding the effectiveness of many non-surgical and non-interventional treatments for lower back pain. "While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time," the authors concluded, as reported by Discover Magazine.
The Chartered Society of Physiotherapists and the Royal College of Physiotherapists both emphasize that "exercise has been shown to be the most helpful treatment for back pain," with manual therapies providing small benefits only when part of a comprehensive treatment program that includes exercise, according to The Guardian.
"With back pain being a leading cause of disability worldwide, the findings underscore the importance of investing in treatments that offer benefits to patients," Cashin said, according to EL PAÍS English Edition. He acknowledged that more research is needed to shed light on a condition whose economic cost ranges between 1.7% and 2.1% of a European country's GDP.
The situation regarding low back pain is expected to worsen, with estimates that by 2030, the prevalence of lower back problems will surpass 800 million people, or 10% of the global population.
The article was written with the assistance of a news analysis system.