Are non-surgical treatments for back pain effective?

Most non-surgical lower back pain treatments offer little relief, with only a few showing modest benefits over placebo, an Australian study found

Shyla Jovitha Abraham : Only about 1 in 10 common non-surgical treatments for lower back pain are effective, and many offer only marginal benefits over placebo, concludes an Australian study published in BMJ Evidence Based Medicine.

Researchers analysed the effectiveness of non-surgical and non-invasive treatments by reviewing 301 clinical trials covering 56 different treatments or treatment combinations. These trials included participants with acute, chronic or both types of low back pain and were conducted across 44 countries in Africa, North America, South America, Asia, Australia and Europe.

For acute low back pain, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen were effective. For chronic low back pain, exercise, spinal manipulation, taping, antidepressants and medications that target pain receptors (TRPV1 agonists) were effective. However, these effects were small. Treatments such as exercise, steroid injections and paracetamol were not effective for acute low back pain, while anaesthetics and antibiotics were not effective for chronic low back pain.

For chronic back pain, evidence was inconclusive for 22 non-pharmacological treatments, including acupuncture, massage, osteopathy and TENS (transcutaneous electrical nerve stimulation) and 16 pharmacological treatments, including antidepressants, paracetamol, complementary medicines, bisphosphonates and muscle relaxants. “Our review did not find reliable evidence of large effects for any of the included treatments,” the researchers concluded.