Key messages

For acute low back pain (pain lasting less than 6 weeks)

• Advice to stay active probably reduces pain and improves function compared to advice to rest in bed.

For subacute low back pain (pain lasting from 6 to 12 weeks)

• Multidisciplinary therapies probably reduce pain compared to usual care.
• Spinal manipulation probably does not improve function compared to placebo (a 'sham' or 'dummy' treatment designed to resemble the actual treatment but lacking active ingredients or the intended therapeutic effect).

For chronic low back pain (pain lasting longer than 12 weeks)

• Acupuncture probably reduces pain and improves function compared to placebo and no treatment/usual care.
• Exercise therapies probably reduce pain and improve function compared to placebo and no treatment/usual care.
• Traction probably does not reduce pain compared to sham traction.
• Multidisciplinary therapy probably reduces pain and improves function compared to usual care.
• Psychological therapies probably reduce pain but make no difference to function compared to usual care.

What is low back pain, and how is it treated?

Low back pain is a common health condition that can be associated with disability and poor quality of life. For most cases of low back pain, the cause of pain is unknown and is described as ‘non-specific’ low back pain. Many types of non-medicine and non-surgical treatments are available for people with low back pain of different durations: acute (pain lasting less than 6 weeks), subacute (pain lasting from 6 to 12 weeks) and chronic (pain lasting longer than 12 weeks). There is a need to provide accessible, high-quality information on the benefits and safety of non-drug and non-surgical treatments for healthcare professionals and patients to better manage low back pain.

What did we want to find out?

We wanted to summarise the evidence from Cochrane reviews on the effectiveness and safety of non-medicine and non-surgical treatments for adults with non-specific low back pain.

What did we do?

We found 31 reviews that included 644 studies with 97,183 participants. The studies investigated the effects of 27 different types of treatment for low back pain.

What did we find?

For people with acute/subacute low back pain, we found that advice to stay active probably reduces pain in the short term (i.e. up to 3 months) compared to advice to rest in bed. We found that multidisciplinary therapies probably reduce pain in the long term (i.e. at 12 months or longer). Spinal manipulation probably does not improve function in the short term.

For people with chronic low back pain, we found that acupuncture, exercise, and psychological therapies probably reduce pain in the short and medium term (i.e. from 3 to 12 months). Acupuncture and exercise probably also improve function in the short and medium term. Multidisciplinary therapies probably reduce pain and improve function in the short and medium term. Traction probably does not reduce pain in the short term.

We have less confidence in the effects of other non-medicine and non-surgical interventions for low back pain.

Non-medicine and non-surgical interventions may not be associated with serious adverse (i.e. unwanted, harmful) events.

What are the limitations of the evidence?

We have reduced confidence in the evidence because we judged that 38% of the reviews did not employ the most rigorous methods available. Almost three-quarters of the reviews were published before 2020, meaning that the evidence they contain may be relatively dated. There is a need to update some Cochrane reviews following recommended guidance.

Because of the quality of the evidence, we are still uncertain about the benefits or risks of many non-medicine and non-surgical treatments commonly used in clinical practice for low back pain. We encourage healthcare professionals, patients, and organisations that fund research on low back pain to use this overview to make informed decisions for low back pain treatment.

How current is this evidence?

This overview is current to April 2023. However, one-third (10 of 31) of the reviews are more than 15 years old, meaning the evidence they contain is even more dated.