Jason, a 42-year-old father of two, has been battling back pain for weeks. Scrolling through his phone, he sees ad after ad promising relief: chiropractic alignments, acupuncture, back braces, vibrating massage guns and herbal patches.
Authors
- Rodrigo Rossi Nogueira Rizzo
Postdoctoral Research Fellow, Neuroscience Research Australia
- Aidan Cashin
NHMRC Emerging Leadership Fellow, Neuroscience Research Australia
His GP told him to "stay active", but what does that even mean when every movement hurts? Jason wants to avoid strong painkillers and surgery, but with so many options (and opinions), it's hard to know what works and what's just marketing hype.
If Jason's experience sounds familiar, you're not alone. Back pain is one of the most common reasons people visit a doctor. It can be challenging to manage, mainly due to widespread misunderstandings and the overwhelming number of ineffective and uncertain treatments promoted.
We assessed the best available evidence of non-drug and non-surgical treatments to alleviate low back pain. Our review - published today by the independent, international group the Cochrane Collaboration - includes 31 Cochrane systematic reviews, covering 97,000 people with back pain.
It shows bed rest doesn't work for back pain. Some of the treatments that do work can depend on how long you've been in pain.
Is back pain likely to be serious?
There are different types of low back pain. It can:
- be short-lived, lasting less than six weeks (acute back pain)
- linger for a bit longer, for six to twelve weeks (sub-acute)
- stick around for months and even years (chronic, defined as more than 12 weeks).
In most cases (90-95%), back pain is non-specific and cannot be reliably linked to a specific cause or underlying disease. This includes common structural changes seen in x-rays and MRIs of the spine.
For this reason, imaging of the back is only recommended in rare situations - typically when there's a clear suspicion of serious back issues, such as after physical trauma or when there is numbness or loss of sensation in the groin or legs.
Many people expect to receive painkillers for their back pain or even surgery, but these are no longer the front-line treatment options due to limited benefits and the high risk of harm.
International clinical guidelines recommend people choose non-drug and non-surgical treatments to relieve their pain, improve function and reduce the distress commonly associated with back pain.
So what works for different types of pain? Here's what our review found when researchers compared these treatments with standard care (the typical treatment patients usually receive) or no treatment.
What helps for short-term back pain
1. Stay active - don't rest in bed
If your back pain is new, the best advice is also one of the simplest: keep moving despite the pain.
Changing the way you move and use your body to protect it, or resting in bed, can seem like to right way to respond to pain - and may have even been recommended in the past. But we know know this excessive protective behaviour can make it harder to return to meaningful activities.
This doesn't mean pushing through pain or hitting the gym, but instead, trying to maintain your usual routines as much as possible. Evidence suggests that doing so won't make your pain worse, and may improve it.
2. Multidisciplinary care, if pain lingers
For pain lasting six to 12 weeks, multidisciplinary treatment is likely to reduce pain compared to standard care.
This involves a coordinated team of doctors, physiotherapists and psychologists working together to address the many factors contributing to your back pain persisting:
neurophysiological influences refer to how your nervous system is currently prepossessing pain. It can make you more sensitive to signals from movements, thoughts, feelings and environment
psychological factors include how your thoughts, feelings and behaviours affect your pain system and, ultimately, the experience of pain you have
occupational factors include the physical demands of your job and how well you can manage them, as well as aspects like low job satisfaction, all of which can contribute to ongoing pain.
What works for chronic back pain
Once pain has been around for more than 12 weeks, it can become more difficult to treat. But relief is still possible.
Exercise therapy
Exercise - especially programs tailored to your needs and preferences - is likely to reduce pain and help you move better. This could include aerobic activity, strength training or Pilates-based movements.
It doesn't seem to matter what type of exercise you do - it matters more that you are consistent and have the right level of supervision, especially early on.
Multidisciplinary treatment
As with short-term pain, coordinated care involving a mix of physical, occupational and psychological approaches likely works better than usual care alone.
Psychological therapies
Psychological therapies for chronic pain include approaches to help people change thinking, feelings, behaviours and reactions that might sustain persistent pain.
These approaches are likely to reduce pain, though they may not be as effective in improving physical function.
Acupuncture
Acupuncture probably reduces pain and improves how well you can function compared to placebo or no treatment.
While some debate remains about how it works, the evidence suggests potential benefits for some people with chronic back pain.
What doesn't work or still raises uncertainty?
The review found that many commonly advertised treatments still have uncertain benefits or probably do not benefit people with back pain.
Spinal manipulation, for example, has uncertain benefits in acute and chronic back pain, and it likely does not improve how well you function if you have acute back pain.
Traction, which involves stretching the spine using weights or pulleys, probably doesn't help with chronic back pain. Despite its popularity in some circles, there's little evidence that it works.
There isn't enough reliable data to determine whether advertised treatments - such back braces, vibrating massage guns and herbal patches - are effective.
How can you use the findings?
If you have back pain, start by considering how long you've had it. Then explore treatment options that research supports and discuss them with your GP, psychologist or physiotherapist.
Your health provider should reassure you about the importance of gradually increasing your activity to resume meaningful work, social and life activities. They should also support you in making informed decisions about which treatments are most appropriate for you at this stage.
Rodrigo Rossi Nogueira Rizzo receives funding from the Australian Government's Medical Research Future Fund (MRFF).
Aidan Cashin receives funding from a National Health and Medical Research Council Investigator Grant
