Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach
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Abstract Introduction: Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. Objective: The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. Methods: A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. Conclusion: The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Acceptance and Commitment Therapy (ACT) is an evidence-based treatment recommended for use in chronic pain management.
“ACT was selected as the psychological intervention based on the strength of literature support as an evidence-based treatment recommended for use in the setting of chronic pain management and its potential for improving difficult to treat subgroups with pain, such as older or less well-educated patients.3,5–7”
From Design and implementation of online acceptance and commitment therapy with enhanced therapist support for chronic low back pain (ACT for PAIN) (2025) · cites this paper as [3]
ACT was selected as the psychological intervention for the BEST Trial based on literature support and its potential for improving difficult-to-treat subgroups with pain, such as older or less well-educated patients.
“ACT was selected as the psychological intervention based on the strength of literature support as an evidence-based treatment recommended for use in the setting of chronic pain management and its potential for improving difficult to treat subgroups with pain, such as older or less well-educated patients.3,5–7”
From Design and implementation of online acceptance and commitment therapy with enhanced therapist support for chronic low back pain (ACT for PAIN) (2025) · cites this paper as [3]
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“In this context, the approaches used for psychological assessment and intervention in chronic pain could embrace a dimensional, process-based framework to enable long-term benefits.”
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Self-citation
- Authors
- Mauck, M. C., Aylward, A. F., Barton, C. E., Birckhead, B., Carey, T., Dalton, D. M., Fields, A. J., Fritz, J., Hassett, A. L., Hoffmeyer, A., Jones, S. B., McLean, S. A., Mehling, W. E., O'Neill, C. W., Schneider, M. J., Williams, D. A., Zheng, P., & Wasan, A. D.
- Affiliations
- Anesthesiology
- University of North Carolina at Chapel Hill (US)
- Johns Hopkins University (US)
- Boston University (US)
- University of California, San Francisco (US)
- University of Utah (US)
- University of Michigan (US)
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
- University of Pittsburgh (US)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Mauck, Matthew C.
- ORCID
- Venue
- PAIN Reports
- Published
- 2022-09
- Volume
- 7
- Issue
- 5
- Pages
- e1019
- ISSN
- 2471-2531 (ISSN-L)
- PMC
- PMC9529058
- OpenAlex
- W4298127187
- Cited by
- 49
- References
- 60
- Citations by year
- 2026: 6 · 2025: 23 · 2024: 12 · 2023: 8
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PAIN Reports (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- OpenBU (Boston University) (publishedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U19AR076734)
- National Center for Complementary and Integrative Health (UH3AT009763)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- chronic low back pain, personalized medicine, treatment selection, evidence-based interventions, duloxetine, acceptance and commitment therapy, exercise therapy, manual therapy, self-management, HEAL Initiative, biomarkers
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