Nonsurgical Options Show Modest Benefit in Chronic Back Pain
METHODOLOGY:
Researchers conducted a systematic review and meta-analysis of 75 randomized or cluster randomized controlled trials involving 15,395 participants aged 16 years or older (mean age, 45.7 years; median percentage of women, 61%) with chronic low back pain lasting at least 12 weeks.
They assessed the effectiveness of nonsurgical interventions for chronic low back pain (including 91% trials on nonspecific chronic low back pain) with a focus on long-term (1-2 years) and very long-term (≥ 2 years) outcomes.
Psychological, physical, and combination nonsurgical interventions, including cognitive-behavioral therapy, mindfulness, and multidisciplinary care, were assessed, with exercise being the most frequently assessed intervention.
Interventions were compared with placebo or sham, adjuvant interventions, no intervention, or usual care.
Pain intensity and disability were assessed using scales like the Numerical Pain Rating Scale and Oswestry Disability Index, respectively, along with other measures, and the certainty of evidence was assessed.
TAKEAWAY:
At long-term follow-up, small-to-moderate reductions in pain intensity and disability were possibly seen with cognitive-behavioral therapy (mean differences, -7.2 and -5.7, respectively) and mindfulness (mean differences, -10.0 and -9.3, respectively) in individuals with nonspecific chronic low back pain. The evidence was of moderate certainty.
Goal setting and needling interventions probably resulted in small reductions in disability, with mean differences of -8.3 and -4.8, respectively.
Multicomponent biopsychosocial care and behavioral therapy might have led to moderate and small reductions, respectively, in pain intensity in those with nonspecific chronic low back pain (mean differences, -10.2 and -7.4, respectively; low-certainty evidence). Multidisciplinary care could have led to small reductions in disability (mean difference, -8.3).
At very long-term follow-up, multidisciplinary care may have led to a moderate reduction in pain intensity (mean difference, -10.1), whereas exercise may have resulted in a moderate decrease in disability (mean difference, -10.2) in those with nonspecific chronic low back pain. The evidence was mostly of low certainty.
IN PRACTICE:
'Although we identified some interventions with long-term effects for people with chronic low back pain, the clinical importance of the effects is uncertain,' the study authors wrote. 'Greater attention is needed on developing and testing interventions with long-term effects for chronic low back pain.'
SOURCE:
The study was led by Hazel J. Jenkins, PhD, Macquarie University, Sydney, Australia. It was published online on May 28, 2025, in The Lancet Rheumatology .
LIMITATIONS:
The certainty of the evidence was reduced for most comparisons because of the quality of the studies and inconsistencies in the results.
DISCLOSURES:
The study reported receiving no specific funding. Some authors reported receiving grants, support for attending meetings, research fellowships, and serving as members of the executive board of the network and/or as members of associations outside the submitted work.
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