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Cited by 1,045Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPain Management and Treatment

Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline

Chou, Roger, Huffman, Laurie Hoyt·2007·Annals of Internal Medicine
DOI 10.7326/0003-4819-147-7-200710020-00007
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Abstract

BACKGROUND: Many nonpharmacologic therapies are available for treatment of low back pain. PURPOSE: To assess benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). DATA SOURCES: English-language studies were identified through searches of MEDLINE (through November 2006) and the Cochrane Database of Systematic Reviews (2006, Issue 4). These electronic searches were supplemented by hand searching of reference lists and additional citations suggested by experts. STUDY SELECTION: Systematic reviews and randomized trials of 1 or more of the preceding therapies for acute or chronic low back pain (with or without leg pain) that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction. DATA EXTRACTION: We abstracted information about study design, population characteristics, interventions, outcomes, and adverse events. To grade methodological quality, we used the Oxman criteria for systematic reviews and the Cochrane Back Review Group criteria for individual trials. DATA SYNTHESIS: We found good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain. Benefits over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland-Morris Disability Questionnaire, or a standardized mean difference of 0.5 to 0.8. We found fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain. For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat (good evidence for moderate benefits) and spinal manipulation (fair evidence for small to moderate benefits). Although serious harms seemed to be rare, data on harms were poorly reported. No trials addressed optimal sequencing of therapies, and methods for tailoring therapy to individual patients are still in early stages of development. Evidence is insufficient to evaluate the efficacy of therapies for sciatica. LIMITATIONS: Our primary source of data was systematic reviews. We included non-English-language trials only if they were included in English-language systematic reviews. CONCLUSIONS: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.

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Crossref · 10.7326/0003-4819-147-7-200710020-00007

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  • Many interventions for chronic low back pain produce some clinical benefit, but few consistently yield substantial long-term pain reduction with improved function.

    “Many of these have shown some clinical benefit, but few appear to consistently provide substantial, long-term reductions in pain with increased function.25, 27–29”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [28]

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Authors
Chou, R., & Huffman, L. H.
Affiliations
Oregon Health & Science University (US)
ORCID
Chou, Roger
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2007-10-02
Volume
147
Issue
7
Pages
492-504
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-147-7-200710020-00007
OpenAlex
W2087110004
Cited by
1,045
References
178
Citations by year
2026: 11 · 2025: 25 · 2024: 27 · 2023: 26 · 2022: 33 · 2021: 37 · 2020: 93 · 2019: 55 · 2018: 51 · 2017: 58 · 2016: 64 · 2015: 63 · 2014: 71 · 2013: 73 · 2012: 79
FWCI
6.33
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
low back pain, non-pharmacological treatment, acupuncture, spinal manipulation, exercise therapy, cognitive behavioral therapy, interdisciplinary rehabilitation, massage, yoga, functional restoration, back school, psychotherapy, physiotherapy, transcutaneous electrical nerve stimulation, low-level laser therapy, traction, lumbar support, sciatica, chronic low back pain, acute low back pain
MeSH terms
Acute Disease, Behavior Therapy, Chronic Disease, Combined Modality Therapy, Humans, Low Back Pain, Practice Guidelines as Topic, Mind-Body Therapies, Physical Therapy Modalities

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