Low back pain – Related resources

Cochrane reviews

Physical therapy and exercise

• Post-treatment exercise programmes appear to prevent recurrences of low-back pain, but there is conflicting evidence on exercise as part of treatment during an episode of back pain .
• Physical conditioning programs seem to reduce sick leaves when compared to usual care in workers with subacute and chronic back pain although the evidence is insufficient.
• Prolotherapy may not be an effective treatment for chronic low-back pain, when used alone. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability .
• Insoles may not prevent back pain. There is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities . Spinal cord stimulation may provide some beneficial effect in chronic pain associated with Failed Back Surgery Syndrome or Complex Regional Pain Syndrome Type I .
There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy .

Surgical therapy

• The evidence on the surgical interventions of spinal decompression, nerve root decompression, and fusion of adjacent vertebrae in the treatment of degenerative lumbar spondylosis is limited and conflicting .
• There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain. However, it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy .
• Radiofrequency denervation appears to offer short-term relief for chronic neck pain of zygapophyseal joint origin and for chronic cervicobrachial pain .
• Interventional pain management techniques, percutaneous adhesiolysis and spinal endoscopy, may be effective interventions to treat low back and lower extremity pain caused by epidural adhesions .

Pharmaceutical therapy

• Harpagophytum procumbens (devil's claw) and Salix alba (white willow bark) appear to reduce pain more than placebo in non-specific low-back pain .

Patient education

• Operant therapy appears to be more effective than waiting list and behavioural therapy more effective than usual care for short-term pain relief in chronic low back pain patients.
• Training workers about proper material handling techniques or providing them with assistive devices appear not to be effective interventions by themselves in preventing back pain. .
• Back-schools appear to be effective for patients with recurrent and chronic low back pain in occupational settings .

Others

• When used in isolation, most physical tests used to identify lumbar disc herniation may have poor diagnostic performance .

Other evidence summaries

• Programmes aiming at prevention of back injury in the workplace (especially back schools and exercise training programmes) may be effective .
• The squat lifting technique may not bring clear advantage .
• Spa therapy and balneotherapy may be effective for treating patients with low back pain .
• Interventional pain management techniques, percutaneous adhesiolysis and spinal endoscopy, may be effective interventions to treat low back and lower extremity pain caused by epidural adhesions .
• Epidural steroid injections may have limited short-term effectiveness in radicular low back pain .
• Group education is probably not effective for people with low back pain .

Clinical guidelines

• Low back pain – Early management of persistent non-specific low back pain. NICE Clinical Guideline 88, 2009
• New Zealand acute low back pain guide. New Zealand Guidelines Group 2004. Pdf document

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