Research Review: Treatment for Non-Specific Low Back Pain | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Research Review: Treatment for Non-Specific Low Back Pain

Research Review: Treatment for Non-Specific Low Back Pain -

Treatment for non-specific low back pain

Non-specific low back pain (NS-LBP) is a leading cause of pain and disability worldwide. Among the therapeutic interventions for NS-LBP, it is not clear which intervention offers the best benefit–harm balance. Uncertainty in the management of NS-LBP is reflected in the often discordant guideline recommendations.

Gianola et al. (2021), explored the relative efficacy of currently available treatments for acute and subacute mechanical NS-LBP in terms of benefit and harm.

Systematic Review

46 RCTs included n=(8765)
Risk of bias was:
  • Low in 9 trials.
  • Unclear in 20.
  • High in 17.

Primary outcomes were pain intensity and disability.
Secondary outcomes were any occurrence of adverse events.

Follow-up times:
  • Immediate-term (closest to 1 week).
  • Short-term (closest to 1-month).
  • Medium-term (closest to 3–6 months).
  • Long-term (closest to 12 months).

Most Effective for pain decrease:
Exercise, heat wrap, opioids, manual therapy, and (NSAIDs).

In the long term, for pain decrease:
The most effective treatment was cognitive behavioral therapy.

Similar findings for disability decrease as with pain.

Mild or moderate adverse events were reported in:
  • opioids (65.7%).
  • NSAIDs (54.3%).
  • Steroids (46.9%).

  • After first line of care, NS-LBP should be managed with nonpharmacological treatments which seem to mitigate pain and disability in the first week.
  • Pain and disability reduction were best achieved by heat wrap, manual therapy and exercise at immediate-term of follow-up.
  • Among pharmacological interventions, pain and disability reduction were best achieved by NSAIDs and muscle relaxants at immediate-term of follow-up.
  • Paracetamol had no benefit over inert treatments at any follow-up assessment; evidence was largely uncertain.

Gianola et al. 2021. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain. BJSM.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
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