Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline
2017/02/13 by Roger Chou, Richard A. Deyo, Richard Deyo +13 · 849 citations
Medicine · Neuroscience · #Acupuncture #Alternative medicine #Chronic pain #Clinical trial #Complementary and Alternative Medicine Studies #Data extraction #Evidence-based medicine #Guideline #Internal medicine #Low back pain #MEDLINE #Manual therapy #Massage #Medicine #Musculoskeletal pain and rehabilitation #Neck pain #Pain Management and Placebo Effect #Physical therapy #Placebo #Randomized controlled trial #Rehabilitation #Spinal manipulation #Systematic review
paper · doi:10.7326/m16-2459
published in Annals of Internal Medicine 166(7), 493-505 (American College of Physicians)
openalex publication_date 2017/02/13 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/02
Abstract
Background: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available. Purpose: To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain. Data Sources: Ovid MEDLINE (January 2008 through February 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. Study Selection: Randomized trials of 9 nonpharmacologic options versus sham treatment, wait list, or usual care, or of 1 nonpharmacologic option versus another. Data Extraction: One investigator abstracted data, and a second checked abstractions for accuracy; 2 investigators independently assessed study quality. Data Synthesis: The number of trials evaluating nonpharmacologic therapies ranged from 2 (tai chi) to 121 (exercise). New evidence indicates that tai chi (strength of evidence [SOE], low) and mindfulness-based stress reduction (SOE, moderate) are effective for chronic low back pain and strengthens previous findings regarding the effectiveness of yoga (SOE, moderate). Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain (SOE, low to moderate). Limited evidence shows that acupuncture is modestly effective for acute low back pain (SOE, low). The magnitude of pain benefits was small to moderate and generally short term; effects on function generally were smaller than effects on pain. Limitation: Qualitatively synthesized new trials with prior meta-analyses, restricted to English-language studies; heterogeneity in treatment techniques; and inability to exclude placebo effects. Conclusion: Several nonpharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind–body interventions. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735)
Citations
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- Prevalence of Pain Diagnoses and Burden of Pain Among Active Duty Soldiers, FY2012. [europepmc]
- Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain. [europepmc]
- Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis. [europepmc]
- Chronic pain and mental health: integrated solutions for global problems. [europepmc]
- Physical Therapy Approaches in the Treatment of Low Back Pain. [europepmc]
- Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. [europepmc]
- Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. [europepmc]
- Integrating Mobile-health, health coaching, and physical activity to reduce the burden of chronic low back pain trial (IMPACT): a pilot randomised controlled trial. [europepmc]
- Massage for Pain: An Evidence Map. [europepmc]
- Complementary and Integrated Health Approaches: What Do Veterans Use and Want. [europepmc]
- Interleukin-8 as a therapeutic target for chronic low back pain: Upregulation in human cerebrospinal fluid and pre-clinical validation with chronic reparixin in the SPARC-null mouse model. [europepmc]
- Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. [europepmc]
- Integrative Medicine Therapies for Pain Management in Cancer Patients. [europepmc]
- Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. [europepmc]
- US Health Care Spending by Payer and Health Condition, 1996-2016. [europepmc]
- Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. [europepmc]
- Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review. [europepmc]
- Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain: A Randomized Clinical Trial. [europepmc]
- Do not routinely offer imaging for uncomplicated low back pain. [europepmc]
- Peripheral and Central Pathological Mechanisms of Chronic Low Back Pain: A Narrative Review. [europepmc]
- Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial. [europepmc]
- Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. [europepmc]
- Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial. [europepmc]
- Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis. [europepmc]
- Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. [europepmc]
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