Efficacy of Non-Surgical and Non-Interventional Treatments in Low Back Pain

A systematic review and meta-analysis of placebo-controlled randomized trials showed that there is moderate certainty evidence that non-steroidal anti-inflammatory drugs (NSAIDs) are efficacious for acute low back pain, and that exercise, spinal manipulative therapy, taping, antidepressants, and transient receptor potential vanilloid 1 (TRPV1) agonists are efficacious for chronic low back pain. The efficacy for the majority of treatments is uncertain due to the limited number of randomized participants and poor study quality. A total of 301 trials (377 comparisons) provided data on 56 different treatments or treatment combinations. One treatment for acute low back pain (NSAIDs), and five treatments for chronic low back pain (exercise, spinal manipulative therapy, taping, antidepressants, TRPV1 agonists) were efficacious; effect sizes were small and of moderate certainty. Three treatments for acute low back pain (exercise, glucocorticoid injections, paracetamol), and two treatments for chronic low back pain (antibiotics, anesthetics) were not efficacious and are unlikely to be suitable treatment options with moderate certainty evidence. Evidence is inconclusive for remaining treatments due to small samples, imprecision, or low and very low certainty evidence. The findings are broadly comparable to previous studies and guidelines and suggest that further high-quality, placebo-controlled trials are warranted to address the remaining uncertainty in efficacy of non-surgical and non-interventional treatments for low back pain. Source: https://ebm.bmj.com/