• Researchers have found one in 10 non-surgical and non-interventional treatments for low back pain are effective and the pain relief provided is only marginally better than placebo.
• Further high-quality, placebo-controlled trials are needed to improve understanding of treatment effectiveness.
• For acute low back pain, there is moderate certainty evidence that NSAIDS (non-steroidal anti-inflammatory drugs) are effective. For chronic low back pain, there is moderate certainty evidence that exercise, spinal manipulative therapy, taping, antidepressants and TRPV1 agonists (eg Capsaicin) are effective.

Only around one in 10 common treatments for low back pain is effective and many offer pain relief that’s barely better than placebo, new research has found.

Deputy Director of the Centre for Pain IMPACT at Neuroscience Research Australia (NeuRA) and Conjoint Senior Lecturer in the School of Health Sciences at UNSW Sydney, Dr Aidan Cashin, said the systematic review was a collaboration by researchers from a number of global institutes, including the University of Sydney, and was published in BMJ Evidence Based Medicine.

“Low back pain is a growing global problem, with the majority of pain classified as non-specific, that is with no immediately identifiable cause,” Dr Cashin said.

“Non-surgical and non-interventional treatments are first-line care for low back, so we wanted to see how effective these are, compared with placebo.

“Surprisingly, we found only around one in 10 was effective and most provided pain relief that was only marginally better than placebo.”

What the research found

The review looked at 301 trials and provided data on 56 different treatments or treatment combinations. These trials included people with acute low back pain, chronic low back pain and some with both types. Studies had to report a continuous measure of pain intensity, as it was a core outcome and often primary treatment target.

“Treatments included in the research were pharmacological, such as non-steroidal anti-inflammatory drugs, or NSAIDs, and muscle relaxants, but also non-pharmacological, like exercise and massage,” Dr Cashin said.

“We found for acute low back pain, non-steroidal anti-inflammatory drugs may be effective. For chronic low back pain, exercise, spinal manipulation, taping, antidepressants and medications that TRPV1 agonists may be effective.

“However, those effects were small. The effectiveness for most treatments is uncertain due to the limited number of randomised participants, and poor study quality.”

Further placebo-controlled trials needed

Dr Cashin said evidence was inconclusive for many treatments. This included both medications and non-pharmacological interventions, for both acute and chronic back pain.

“We need further high-quality, placebo-controlled trials to understand the efficacy of treatments and remove the uncertainty for both patients and clinical teams,” Dr Cashin said.

“Placebo-controlled studies are the gold standard for evaluating the effects of treatments, with a clear need to better understand which treatments work for people with low back pain.”

Dr Cashin said people with low back pain should talk to their medical team to understand the treatments available and best suited to their individual situation.

The full paper is available here.