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Low back pain: Which treatments work? - The evidence.

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Less invasive treatments should be first port of call for low back pain.

Take Home Messages:

There are may options for the treatment of low back pain, including interdisciplinary rehabilitation, epidural steroid injections and surgery.

Less invasive treatment should be trialed first as more invasive treatments are associated with an increased risk of complications.

Sophisticated tests and imaging are often unhelpful in diagnosis.

Why the research matters:

Low back pain is a common and debilitating disorder. Therefore, it is important that effective treatments are identified so that a management plan can be provided to the individual that leads to the best possible outcome.

What the research involved:

This study aimed to produce evidence based guidelines for the diagnosis and management of low back pain. A panel of 23 experts was assembled by the American Pain Society in 2004 to review the available evidence regarding the diagnosis and management of low back pain. Based on this evidence, the panel made several recommendations.

Summary of research findings:

In patients with chronic, localised low back pain, provocative discography – an invasive procedure which necessitates an injection into the affected disc – is NOT recommended as a diagnostic procedure.

Patients with localised low back pain who do not improve following usual treatment should be referred for interdisciplinary rehabilitation. This involves health professionals from different disciplines and addresses the psychological and environmental factors as well as the physical factors that impact on low back pain.

Facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injection are not recommended as treatments for localised low back pain.

Surgery should be considered as an option in patients with severe, disabling localised low back pain and spinal degeneration. However, it should be emphasised that surgery provides only SLIGHTLY better results than interdisciplinary rehabilitation and that MOST PEOPLE ARE NOT CURED COMPLETELY.

Epidural steroid injection may be considered in patients with non-localised radiating low back pain. However, it must be emphasised that there is inconsistent evidence supporting epidural steroid injection, and that this treatment only produces short-term benefits.

Spinal cord stimulation may be considered in patients with persistent pain following surgery for a herniated disc. However, the patient must be made aware of the high rate of complications associated with this treatment before making a decision.

Original research:

Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.

Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel.

Spine. 2009 May 1;34(10):1066-77.

Link to PubMed abstract

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Low back pain: Which treatments work? - The evidence.

Take Home Messages:

Why the research matters:

What the research involved:

Summary of research findings:

Original research:

We want to empower our readers ...

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