Research Review: Treatment for Non-Specific Low Back Pain

Treatment for non-specific low back pain

INTRO:
Non-specific low back pain (NS-LBP) is a leading cause of pain and disability worldwide. Among the therapeutic interventions for NS-LBP, it is not clear which intervention offers the best benefit–harm balance. Uncertainty in the management of NS-LBP is reflected in the often discordant guideline recommendations.

Gianola et al. (2021), explored the relative efficacy of currently available treatments for acute and subacute mechanical NS-LBP in terms of benefit and harm.

METHODS:
Systematic Review

46 RCTs included n=(8765)
Risk of bias was:

Low in 9 trials.
Unclear in 20.
High in 17.

Primary outcomes were pain intensity and disability.
Secondary outcomes were any occurrence of adverse events.

Follow-up times:

Immediate-term (closest to 1 week).
Short-term (closest to 1-month).
Medium-term (closest to 3–6 months).
Long-term (closest to 12 months).

RESULTS:
Most Effective for pain decrease:
Exercise, heat wrap, opioids, manual therapy, and (NSAIDs).

In the long term, for pain decrease:
The most effective treatment was cognitive behavioral therapy.

Similar findings for disability decrease as with pain.

Mild or moderate adverse events were reported in:

opioids (65.7%).
NSAIDs (54.3%).
Steroids (46.9%).

CONCLUSIONS:

After first line of care, NS-LBP should be managed with nonpharmacological treatments which seem to mitigate pain and disability in the first week.
Pain and disability reduction were best achieved by heat wrap, manual therapy and exercise at immediate-term of follow-up.
Among pharmacological interventions, pain and disability reduction were best achieved by NSAIDs and muscle relaxants at immediate-term of follow-up.
Paracetamol had no benefit over inert treatments at any follow-up assessment; evidence was largely uncertain.

SOURCE:
Gianola et al. 2021. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain. BJSM.

Reposted with permission from @physicaltherapyresearch on instagram

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.

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