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

Roger Chou, Laurie Hoyt Huffman

Research output: Contribution to journalArticle

624 Citations (Scopus)

Abstract

Background: Many nonpharmacologic therapies are available for treatment of low back pain. Purpose: To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). Data Sources: English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching of reference lists and additional citations suggested by experts. Study Selection: Systematic reviews and randomized trials of 1 or more of the preceding therapies for acute or chronic low back pain (with or without leg pain) that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction. Data Extraction: We abstracted information about study design, population characteristics, interventions, outcomes, and adverse events. To grade methodological quality, we used the Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials. Data Synthesis: We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. Benefits over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland-Morris Disability Questionnaire, or a standardized mean difference of 0.5 to 0.8. We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain. For acute low back pain (

Original languageEnglish (US)
Pages (from-to)492-504
Number of pages13
JournalAnnals of Internal Medicine
Volume147
Issue number7
StatePublished - Oct 2 2007

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Low Back Pain
Practice Guidelines
Physicians
Spinal Manipulation
Yoga
Massage
Acupuncture
Therapeutics
Leg
Diathermy
Transcutaneous Electric Nerve Stimulation
Exercise Therapy
Pain
Job Satisfaction
Information Storage and Retrieval
Traction
Cognitive Therapy
Population Characteristics
Pain Measurement
Back Pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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