A comprehensive analysis of 301 clinical trials reveals that only about 10% of non-surgical and non-invasive treatments for lower back pain are effective, with most offering only marginal benefits over placebos. Published in BMJ Evidence-Based Medicine, the study highlights the challenges in treating non-specific low back pain, which accounts for 80%-90% of cases, and calls for more high-quality research to identify effective therapies.
The study, which pooled data from trials conducted across 44 countries, evaluated 56 different treatments or combinations, including pharmacological options like NSAIDs and muscle relaxants, and non-pharmacological approaches such as exercise, massage, and spinal manipulation. Researchers found that for acute low back pain, only NSAIDs showed effectiveness compared to placebos, while for chronic pain, exercise, spinal manipulation, taping, antidepressants, and TRPV1 agonists were somewhat effective, though the benefits were small.
Moderate-quality evidence indicated that many commonly used treatments, such as steroid injections, paracetamol, and antibiotics, were ineffective for acute or chronic pain. Additionally, the evidence for a wide range of treatments, including acupuncture, massage, and osteopathy, was inconclusive, largely due to small sample sizes and inconsistent results across trials.
The researchers noted, “Our review did not find reliable evidence of large effects for any of the included treatments, which is consistent with clinical guidelines and our previous review. While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time.”
The study underscores the need for larger, high-quality placebo-controlled trials to reduce uncertainty in the efficacy of non-surgical treatments for lower back pain. With non-specific low back pain being a leading cause of disability worldwide, the findings highlight the urgent need for more effective and evidence-based treatment options.
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