• Researchers have found that a combination of staying active and multidisciplinary interventions are important in treating low back pain.
• Low back pain is a leading a cause of disability and reduced quality of life globally, with an estimated 4 million Australians having back problems and most people suffering from an episode of lower back pain at some stage in their lives.
• Updated research into the effectiveness and safety of treatments is required to better understand and manage low back pain.

Low back pain is a leading cause of disability globally, but researchers from Neuroscience Research Australia and UNSW Sydney have found staying active and taking a multidisciplinary approach are key treatments.

NeuRA Senior Research Scientist and Director of the Centre for Pain IMPACT, Professor James McAuley, said while many treatments are promoted as being beneficial for low back pain, his team had conducted a comprehensive review of the global research.

What is low back pain?

“Low back pain is pain between the lower edge of the ribs and buttocks and can vary in its nature and severity,” Prof McAuley said.

“It is a huge problem globally and impacts around 16% of the Australian population.

“While many non-drug and non-surgical treatments are promoted, we wanted to see what the evidence actually showed regarding effectiveness and presence of adverse effects.”

Researchers looked at evidence from a wide range of studies up to April 2023 that included nearly 100,000 participants, considering pain defined as acute (less than six weeks), subacute (six to 12 weeks), and chronic (longer than 12 weeks).

Different types of low back pain require different treatments

“Whilst we use the term ​‘low back pain’, there are actually different types and they require different treatments,” Prof McAuley said.

“For example, staying active is beneficial for acute low back pain, helping to reduce pain and improve function compared to excessive protective behaviours, such as staying in bed.

“However, if you have subacute low back pain, multidisciplinary therapies that consider physical, psychological and occupational aspects are likely to provide better pain relief. For example, physiotherapy, but also psychology or occupational therapy, typically delivered by multiple clinicians. Interestingly, spinal manipulation and hands-on treatment likely didn’t improve function, and the effects on pain relief are uncertain.

“For people who have chronic low back pain, acupuncture, exercise therapies and multidisciplinary therapies are likely to improve pain and function, whilst traction likely doesn’t improve pain. Psychological therapy for pain management may be another effective intervention to reduce pain, but probably not to improve function.”

Postdoctoral Research Fellow, Dr Rodrigo Rizzo, also worked on the project and said more research is needed into many other common non-drug and non-surgical treatments for low back pain, as there is less clear evidence of benefit. However, he also noted that most of these treatments are not associated with serious adverse events.

“Understanding the effectiveness and safety of treatments is crucial for better management and can help clinicians, patients and healthcare providers make informed decisions about managing low back pain,” Dr Rizzo said.

The researchers also found the need to update existing Cochrane Reviews and continue investigating the effectiveness and safety of treatments, as 74% were published more than five years ago.

The full report is available here.