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Back Pain Research Review
Conservative Treatment of Acute and Chronic Low Back Pain
Conservative treatment refers basically to all non-surgical treatment methods, excluding psychological treatment (discussed separately below). Conservative treatment methods include drugs, acupuncture, injections of various types, back exercises, back school, manual treatment, manipulation, physical methods, traction, corsets, TENS (transcutaneous electrical nerve stimulation), behavioral therapy, multidisciplinary treatment, biofeedback, rest, and activation. The appendix to this summary presents an overview of the effects of various treatment methods. Here, the only conclusions presented on conservative treatment methods are those supported by strong evidence.
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For acute low back pain, there is strong evidence that:
- continuing with normal activities results in faster recovery and
- fewer chronic functional disorders,
- anti-inflammatory and muscle relaxant drugs offer effective
- pain relief for uncomplicated, acute, low back pain (however, these drugs have some side effects),
- bed-rest is not effective treatment for acute low back pain, and exercises involving bending, traction, aerobics, and stretching do not effectively cure acute low back pain.
For chronic low back pain, there is strong evidence that: manual treatment/manipulation, back training, and multidisciplinary treatment are effective in relieving pain.
Intensive treatment at a health resort reduces pain in the short term for elderly patients (over 60 years of age) with chronic low back problems.
Conservative Treatment Methods for Low Back Pain
Medication
Strong scientific evidence shows that muscle relaxants, (eg, benzodiazepines) and anti-inflammatory drugs (NSAIDs) relieve pain in patients with acute and subacute low back problems, ie, problems which have existed up to 3 weeks or up to 12 weeks (A). However, anti-inflammatory drugs can have serious side effects, particularly in elderly people, and muscle relaxants can cause tiredness and dependency, even after short-term use. Furthermore, there is moderate scientific evidence that paracetamol is effective in relieving acute low back pain (B).
Limited scientific evidence suggests that these drugs are effective in treating chronic low back pain (C). For example, only one study was found that compared the effects of muscle relaxants with the effects of placebo (ie, no active treatment), but no such studies address analgesics and NSAIDs in people with chronic low back problems.
There are no studies on the effects of anti-depressants in treating acute low back problems (D). However, moderate evidence suggests that these drugs do not have any effect on pain and mobility in patients with chronic low back disorders (B).
Studies show that only limited evidence supports the treatment effects of colchicine (medication for gout) and cortisone in tablet form (system steroids) on acute low back pain (C).
Serious side effects have been reported for colchicine, but for system steroids such side effects accompany only long-term use.
Injections
Several different types of injections are used at times to treat both acute and chronic back problems. The injections reviewed were: epidural steroid injections, ie, injections in the spinal cord canal, injections in trigger points and ligaments, and injections in facet joints (small joints in the vertebral column).
Limited evidence suggests that epidural steroid injections are more effective than placebo for acute and chronic low back problems involving nerve root pain (C). There are no studies addressing the effects of these injections on acute low back problems without nerve root pain (D). However, moderate evidence suggests that these injections do not have any effects on chronic low back pain without root symptoms (B).
There is no evidence on the effects of injections in trigger points, ligaments, or facet joints (D).
Back School
There is limited evidence on the effects of back school on chronic and acute low back problems (C).
Conservative Treatment of Acute and Chronic Neck Pain
Conventional treatment methods that are normally used to treat neck pain are largely similar to those used to treat low back problems. The treatment methods reviewed in this report include drugs, physical training, manual treatment, massage, body exercises, muscle training, heat packs, ergonomic counseling, traction, acupuncture, TENS, electromagnetic treatment, magnet therapy, patient education, behavioral therapy, steroid injections, and treatment involving neck collars, infrared light, ultrasound, lasers, cooling spray, and stretching.
Only a few studies in this field are of high scientific quality. In summary, only moderate or limited evidence is available to show that any of the treatment methods are effective in treating acute or chronic neck pain. However, there is strong evidence to show that acupuncture is not an effective method in treating chronic neck pain (A).
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