Low back pain (acute)

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may increase in severity and duration over time. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments for acute low back pain? What are the effects of local injections for acute low back pain? What are the effects of non-drug treatments for acute low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics (paracetamol, opioids), back exercises, back schools, bed rest, behavioural therapy, electromyographic biofeedback, epidural corticosteroid injections, lumbar supports, massage, multidisciplinary treatment programmes, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), traction, and transcutaneous electrical nerve stimulation (TENS).

Cite as

McIntosh G and Hall H. Low back pain (acute). Clinical Evidence 2011; 05:1102.

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Substantive changes

Muscle relaxants New evidence added.[10][13][18] Categorisation unchanged (Trade-off between benefits and harms).

NSAIDs New evidence added.[10][19][21] Categorisation unchanged (Trade-off between benefits and harms).

Analgesics (paracetamol, opioids) New evidence added.[19] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Multidisciplinary treatment programmes (subacute low back pain) New evidence added.[32] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Spinal manipulation One systematic review (149 people)[10] and one subsequent RCT (101 people)[34]added at this update. The review and RCT found no significant difference between spinal manipulation and placebo or usual care in pain. One further study added in harms which reports on adverse effects after spinal manipulation.[37] Categorisation of spinal manipulation changed from Likely to be beneficial to Unknown effectiveness.

Back schools New evidence added.[42] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Behavioural therapy New evidence added.[43] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Lumbar supports New evidence added.[44] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Massage New evidence added.[45] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Temperature treatments (short-wave diathermy, ultrasound, ice, and heat) New evidence added.[48] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

TENS New evidence added.[10] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Back exercises New evidence added.[43] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effects of this intervention.

Latest citations

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