The truth about treating low back pain
Multiple nonpharmacologic therapies have small-to-moderate benefits for low back pain (Table 2). In acute low back pain (<4 weeks), spinal manipulation often is useful. Subacute low back pain (4 to 8 weeks) may improve with intensive interdisciplinary rehabilitation, including cognitive-behavioral therapy (CBT), and can increase functional status and reduce work absenteeism. For chronic low back pain, CBT or progressive relaxation, spinal manipulation, acupuncture, and other modalities have mild to moderate effectiveness.
Table 2
Nonpharmacologic modalities for low back pain
| Duration of back pain | Treatment modality |
|---|---|
| Acute (<4 weeks) | Spinal manipulation |
| Subacute (4 to 8 weeks) | Intensive interdisciplinary rehabilitation (physician consultation, psychological and physical therapy, social and vocational intervention, cognitive-behavioral therapy [CBT]) |
| Chronic (>8 weeks) | Acupuncture, exercise, massage therapy, yoga, CBT, progressive relaxation, spinal manipulation, intensive interdisciplinary rehabilitation |
| Source: Reference 5 | |
- Last AR, Hulbert K. Chronic low back pain: evaluation and management. Am Fam Physician. 2009;79(12):1067-1074.
- Exercise for a better back. www.backcare.org.uk/CMS/files/702-exercise-for-a-better-back.pdf. Accessed April 12, 2010.
Drug brand names
- Cyclobenzaprine • Flexeril
- Tramadol • Ultram, Ultram ER
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
