Only one in ten treatments for back pain actually work, a study suggests.
The experts found that just one treatment for acute low back pain and five treatments for chronic – or long-term – back pain were ‘efficacious.’
These include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for short-term back pain.
For long-term back pain, the treatments found to be effective were exercise, spinal manipulative therapy, taping, antidepressants and drugs that target the pain receptors transient receptor potential vanilloid 1 (TRPV1).
But even these were only found to have ‘slight’ or ‘small’ reductions in pain compared with a placebo – or dummy drug taht looks or feels like the real thing.
The researchers admit they are unable to strongly recommend any particular form of therapy because the potential benefits are minimal.
But there are also many they have dismissed as ‘not efficacious’ or inconclusive.
And of the ones that do work, the experts note they are barely more effective than a placebo.
A new study from researchers in Australia suggests only one in 10 back pain treatments are effective (stock image)
The findings will come as a blow to the millions of Americans and Brits who suffer from back pain, which can often be debilitating.
It is the most common form of pain experienced by adults, with lower back pain affecting eight in 10 Americans and six in 10 Brits.
However, there is usually no immediately identifiable cause.
The researchers, from the University of New South Wales in Australia, called for more research to find treatments for back pain.
The authors wrote: ‘Our review did not find reliable evidence of large effects for any of the included treatments.
‘While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time.
‘There is a clear need for large, high-quality, placebo-controlled trials to reduce uncertainty in efficacy estimates for many non-surgical and non-interventional treatments.’
Writing in the journal BMJ, researchers examined 301 previous trials covering 56 non-surgical treatments for back pain in adults.
Patients reported pain intensity at the start of the trial and again after treatment.
The study authors wrote: ‘Best available evidence shows that one in ten common non-surgical and non-interventional treatments for low back pain are efficacious, providing small analgesic effects beyond placebo.’
They also noted exercise, the pain medication paracetamol – Tylenol or Panadol – and corticosteroid injections ‘probably provides little to no difference in pain’ for acute lower back issues.
Antibiotics and anesthetics were also found to be ‘not efficacious’ for long-term lower back problems.
The rest of the interventions studied had ‘inconclusive evidence,’ prompting the authors to call for more studies to examine the ‘remaining uncertainty’ surrounding a number of back pain treatments.
While the evidence was deemed to be inconclusive, the information available did point to some of these being effective for acute back pain.
For example, the authors found that the certainty of the evidence for acupuncture was ‘low,’ but the information that is available in the reviewed studies suggests that it may provide moderate reductions in pain for both short and long-term back pain.
And while massage is said to have large reductions in pain, the evidence surrounding this claim is ‘very low.’
The CDC recommends using ice, heat, elevation, rest, immobilization, and exercise for pain management, along with NSAIDs and acetaminophen.
Muscle taping was one of the few effective treatments, as it is shown to reduce inflammation and improve posture. However, the experts did not have enough evidence to ‘strongly recommend’ it (stock image)
The pain medication paracetamol – Tylenol or Panadol ‘probably provides little to no difference in pain’ for acute lower back issues, according to the researchers
UK care watchdog National Institute for Health and Care Excellence (Nice) says diagnosis of back pain includes a variety of symptoms, which means that ‘one approach to treatment does not fit all.’
Patients should be offered access to a greater range of treatments if initial approaches do not work, it adds.
Ash James, director of practice and development at the Chartered Society of Physiotherapy, said: ‘Back pain is complex, with many contributing factors, so no single treatment will work for everyone, all the time.
‘Physiotherapists are skilled at identifying the root causes of pain and tailoring treatments to meet the unique needs of each individual.
‘Through a person-centered approach, they can explore a wide range of factors that may contribute to discomfort, such as stress, fear of movement, poor sleep, smoking, obesity, job-related strain, and insufficient physical activity.
‘Most cases of back pain, while uncomfortable, are not serious and, with the right advice and early intervention, usually resolve quickly.’
The study researchers said there were several limitatinos, with the main one being small sample sizes in the included studies and inconsistent results.
