Most back pain treatments don’t work, study finds

Chronic back pain is the most common type of pain, affecting around 16 million American adults — and now a new study has revealed some discouraging findings about potential treatments.

Only around one in every 10 treatments was found to be effective in relieving lower back pain, according to a new study published in BMJ Evidence-Based Medicine.

Many of them are “barely better than a placebo” in terms of pain relief, as stated in a press release from the University of New South Wales (UNSW) in Sydney, Australia.

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“Our review did not find reliable evidence of large effects for any of the included treatments,” said lead study author Dr. Aidan Cashin, deputy director of the Centre for Pain IMPACT at Neuroscience Research Australia (NeuRA) and conjoint senior lecturer in the School of Health Sciences at UNSW Sydney.

The researchers reviewed 301 randomized, controlled trials that included data on 56 non-surgical treatments for adults experiencing acute low back pain, chronic low back pain or a combination of both types, comparing them to groups that received placebos.

“Treatments included in the research were pharmacological, such as non-steroidal anti-inflammatory drugs – or NSAIDs – and muscle relaxants, but also non-pharmacological, like exercise and massage,” Cashin said.

Effective and ineffective treatments

Ineffective treatments for acute low back pain included exercise, steroid injections and paracetamol (acetaminophen), the study found.

For chronic low back pain, antibiotics and anaesthetics were also “unlikely to be suitable treatment options,” the study found.

For acute low back pain, non-steroidal anti-inflammatory drugs (NSAIDs) could be effective, the study found.

For chronic low back pain, therapies including exercise, taping, spinal manipulation, antidepressants and transient receptor potential vanilloid 1 (TRPV1) agonists may be effective — “however, those effects were small,” Cashin noted.

“Things like stress, sleep quality, fatigue, fear, social situations, nutrition, sickness and previous history of pain all play a role in how we experience pain.”

The findings were “inconclusive” for many other treatments due to the “limited number of randomized participants and poor study quality,” the researchers stated.

“We need further high-quality, placebo-controlled trials to understand the efficacy of treatments and remove the uncertainty for both patients and clinical teams,” Cashin said.

Dr. Stephen Clark, a physical therapist and chief clinical officer at Confluent Health in Georgia, noted that the study was looking at “isolated interventions.”

“They excluded studies where it was not possible to isolate the effectiveness of the target intervention,” Clark, who was not involved in the study, told Fox News Digital.

‘Complex condition’

Pain is a complex condition influenced by many different factors, according to Clark.

“Determining a specific cause of low back pain, particularly when the pain is persistent, is difficult, as the BMJ study points out,” he said.

“Things like stress, sleep quality, fatigue, fear, social situations, nutrition, sickness and previous history of pain all play a role in how we experience pain.”

Clark recommends “multimodal” treatments for pain, including multiple interventions tailored to each individual patient’s experience.

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“Physical therapy research shows that manual therapy (joint mobilization/manipulation, soft tissue techniques), active interventions like exercise, and education about why you hurt and what to do about it is the ticket,” he said. 

“It’s also important to remember that what worked for someone else might not be the exact pathway that works for you.”

While surgical intervention can be effective for some patients, Clark noted that it can present its own challenges and should be a “last resort” for non-emergency situations.

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“While surgery is indicated in some cases, it’s almost never the answer in isolation,” he said. “Understanding pain and the complexity around a person’s situation must be in view.”

“In many cases, conservative care can prevent or delay the need for invasive procedures.”