Low back pain (acute): non-drug treatments

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Up to 85% of patients with low back pain cannot be given a definitive diagnosis, the cause or mechanism of injury is often unknown and there is little consensus on appropriate management. As a result, acute low back pain has become a complex and costly therapeutic challenge.

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Focus of the review

The dose, contents, and settings of treatment programmes vary widely in non-drug treatments for acute low back pain; patient characteristics are often dissimilar. An examination of the quantity and quality of this research is required so that the context of treatment conclusions can be better understood.

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Comments on evidence

The literature is full of methodological limitations; inadequate design and reporting of trials frequently produce low- or very low-quality evidence. The results are often inconclusive, insufficient, or contradictory.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, December 2009, to October 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 1379 studies. After deduplication and removal of conference abstracts, 720 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 598 studies and the further review of 120 full publications. Of the 120 full articles evaluated, five systematic reviews and four RCTs were added at this update.

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Substantive changes at this update

Advice to stay active One systematic review updated.[11] Categorisation unchanged (likely to be beneficial).

Acupuncture Option restructured. One systematic review added.[13] Categorisation unchanged (unknown effectiveness).

Back exercises Two systematic reviews[11][19] and two RCTs added.[21][22] Categorisation unchanged (unknown effectiveness).

Multidisciplinary treatment programmes (subacute low back pain) One RCT added to Comment section.[32] Categorisation unchanged (unknown effectiveness).

Spinal manipulation One systematic review updated,[33] one systematic review added,[35] and one RCT added.[36] Categorisation unchanged (unknown effectiveness).

Temperature treatments (short-wave diathermy, ultrasound, ice, and heat) Option restructured; evidence re-evaluated. Categorisation unchanged (unknown effectiveness).

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 overview, aiming to answer the following clinical question: 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 October 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 1379 studies. After deduplication and removal of conference abstracts, 720 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 598 studies and the further review of 120 full publications. Of the 120 full articles evaluated, five systematic reviews and four RCTs were added at this update. We performed a GRADE evaluation for 46 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for nine interventions based on information relating to the effectiveness and safety of acupuncture, advice to stay active, back exercises, massage, multidisciplinary treatment programmes (for acute and subacute low back pain), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), and transcutaneous electrical nerve stimulation (TENS).

Cite as

McIntosh G, Hall H. Low back pain (acute): non-drug treatments. Systematic review 1102. BMJ Clinical Evidence. . 2015 August. Accessed [date].

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