References:

1.         Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T,

Kraegel P, Griffin J, Grusing S, Brodt E. Noninvasive Treatments for Low Back Pain [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb. Available from http://www.ncbi.nlm.nih.gov/books/NBK350276/


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2.         Chou R, Huffman LH, American Pain Society, et al. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505-14.

3.         Chou R, Huffman LH, American Pain Society, et al. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492-504.

4.         Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.

Table 1

Study Outcomes:

  • Reduction or elimination of low back pain
  • Related leg symptoms
  • Improvement in back-specific and overall function
  • Improvement in health-related quality of life
  • Reduction in work disability/return to work
  • Global improvement
  • Number of back pain episodes/time between episodes
  • Patient satisfaction
  • Adverse effects
    • Serious (eg, anaphylaxis with medications, neurological complications, death)
    • Less serious

Table 2 

Pharmacologic Interventions Studied for Low Back Pain

  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Opioids
  • Skeletal muscle relaxants
  • Benzodiazepines
  • Antidepressants
  • Antiseizure medications
  • Systemic corticosteroids
  • Topical/patch-delivered medications

Table 3

Nonpharmacologic Interventions Studied for Low Back Pain

  • Psychological therapies
  • Multidisciplinary rehabilitation
  • Spinal manipulation
  • Acupuncture
  • Massage
  • Exercise and related therapies
  • Various physical modalities (ultrasound, transcutaneous electrical nerve stimulation, electrical muscle stimulation, interferential therapy, heat, and ice, traction tables/devices, back supports/bracing)
  • Yoga Magnets
  • Low-level lasers

Table 4

Review Findings: Pharmacologic Interventions

Condition Pharmacologic Agent Finding Strength of Evidence
Acute low back pain
NSAIDS More effective than placebo, no intervention, or usual care Low to moderate
Skeletal muscle relaxants More effective than placebo, no intervention, or usual care Moderate
Opioids More effective than placebo, no intervention, or usual care Low
Exercise More effective than placebo, no intervention, or usual care Low
Superficial heat More effective than placebo, no intervention, or usual care Moderate
Acetaminophen No more effective than placebo Low
Systemic corticosteroids No more effective than placebo Low
Chronic low back pain
  • NSAIDS
  • Opioids
  • Tramadol
  • Duloxetine
  • Multidisciplinary rehabilitation
  • Acupuncture
  • Exercise
  • More effective than placebo, sham, no treatment, usual care, or wait list Moderate
  • Benzodiazepines
  • Psychological therapies
  • Massage
  • Yoga
  • Tai chi
  • Low-level laser therapy
  • More effective than placebo, sham, no treatment, usual care, or wait list Low
    Spinal manipulation As effective as other active interventions Moderate

    NSAIDS=nonsteroidal anti-inflammatory drugs