CLINICAL QUESTION

Are nonpharmacologic and nonsurgical treatment options safe and effective for nonspecific acute or chronic low back pain?

EVIDENCE-BASED ANSWER

Patients with nonspecific acute low back pain lasting less than 6 weeks should be advised to stay active; continued activity improves pain intensity and function more than rest.¹ Spinal manipulation does not improve short-term function compared with placebo. (Strength of Recommendation [SOR]: B, inconsistent patient-oriented evidence.)

In patients with nonspecific chronic low back pain, multidisciplinary interventions and exercise therapy reduce pain intensity for subacute and chronic low back pain compared with no treatment or usual care.¹ Acupuncture moderately reduces pain intensity and improves function vs no treatment. Psychological therapies using techniques such as progressive muscle relaxation and behavioral approaches reduce pain but have no impact on function compared with usual care. Traction is ineffective. (SOR: B, inconsistent patient-oriented evidence.)

Nonpharmacologic and nonsurgical treatments are probably safe, although data regarding serious adverse effects are limited.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)