Few Nonsurgical Treatments Show Effectiveness for Low Back Pain

WEDNESDAY, March 19, 2025 (HealthDay News) — For acute low back pain, there is moderate-certainty evidence that nonsteroidal anti-inflammatory drugs are an effective treatment, while there is moderate-certainty evidence that exercise, spinal manipulative therapy, taping, antidepressants, and transient receptor potential vanilloid 1 (TRPV1) agonists are efficacious for chronic low back pain, according to a review published online March 18 in BMJ Evidence-Based Medicine.

Aidan G. Cashin, Ph.D., from the Centre for Pain IMPACT at Neuroscience Research Australia in Randwick, and colleagues conducted a systematic literature review to investigate the efficacy of nonsurgical and noninterventional treatments versus placebo for adults with low back pain.

Based on data from 301 trials (377 comparisons for 56 different treatments or treatment combinations), the researchers found that one treatment for acute low back pain (nonsteroidal anti-inflammatory drugs) and five treatments for chronic low back pain (exercise, spinal manipulative therapy, taping, antidepressants, and TRPV1 agonists) were efficacious, although effect sizes were small and of moderate certainty. No effectiveness was seen for three treatments for acute low back pain (exercise, glucocorticoid injections, and acetaminophen) and two treatments for chronic low back pain (antibiotics and anesthetics); based on moderate-certainty evidence, these modalities were unlikely to be suitable treatment options. Small samples, imprecision, or low and very-low certainty evidence made evidence inconclusive for remaining treatments.

“Around 10 percent of nonsurgical and noninterventional treatments provided small analgesic effects beyond placebo,” the authors write.

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