Most adults will have experienced short-term or acute low back pain (LBP) at least once in their lives. Normally, it resolves after six weeks or so. Unfortunately, for many people, acute LBP doesn't resolve and becomes a chronic issue. Treatment of acute and chronic LBP depends on whether the pain is specific (has a determinable cause) or non-specific.

While medications are often the first-line treatment for LBP, non-pharmaceutical treatments, such as physical therapy, can help. Now, researchers from the University of New South Wales (UNSW) Sydney and Neuroscience Research Australia (NeuRA) have reviewed non-drug, non-surgical treatments for LBP to determine the most effective ones.

"Low back pain is pain between the lower edge of the ribs and the buttocks and can vary in its nature and severity," said Professor James McAuley, senior research scientist at NeuRA, director of the Center for Pain IMPACT, and the study's senior author. "While not many non-drug and non-surgical treatments are promoted, we wanted to see what the evidence actually showed regarding effectiveness and presence of adverse effects."

The researchers undertook a Cochrane review, which seeks to answer a specific research question by bringing together and evaluating evidence from human studies. It's considered the pinnacle of evidence-based healthcare. Cochrane reviews are freely available and housed online in the Cochrane Library.

For the present review, the researchers assessed 31 Cochrane reviews of 644 randomized controlled trials that included 97,183 adult participants with LBP without a specific cause. The researchers categorized treatments according to pain duration in keeping with the World Health Organization's (WHO) definitions and compared the effectiveness of non-drug/non-surgical interventions to placebo/sham treatments or no treatment/usual care at follow-up less than or equal to three months.

It's important to know that Cochrane reviews intentionally use terms like "probably" and "may." They're based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, a tool used to assess evidence quality and strength-of-evidence recommendations produced in synthesis reports. Where "probably" is used, the reviewers think the evidence is of moderate quality; that is, the true effect is probably close to the estimated effect.

"We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews," the researchers said.