Summary: Scientific evidence of treatment methods for back pain disorders

This article summarizes the evidence for treatment methods for lumbago from the research papers that the author has used as references. These results may provide a reference for caring for low back pain syndrome, but each study may have different conditions, so it is not clear whether they are suitable for all low back pain syndrome.

Therefore, the results of these articles should be judged with caution.

Evidence for Yoga

Although there is low evidence from 12 trials and a study of 1080 people that related functions of the low back can be expected to improve by a small to moderate amount in 3 to 6 months compared with a control group that did not exercise, the effect size does not meet the minimum level of clinical importance. Therefore, it is unclear whether the results of yoga alone or in combination with multiple other methods are effective.

Wieland LS, Skoets N, Pilkington K, Vempatti R, D'Adamo CR, Berman BM. yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. no.: CD010671. doi: 10.1016/j.j.j.2017.03.003. 10.1002 / 14651858.CD010671.pub2. 

Evidence for Behavior Therapy

According to the Prefecture K'n Rapid, which included 30 randomized trials and 3438 participants, operant therapy was more effective than the control group for short-term pain relief, but there was no difference between operant therapy, cognitive therapy, or combined behavioral therapy.

Behavioral therapy was more effective than usual for short-term pain relief, but there is no difference in medium- to long-term or functional status.

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioral therapy for chronic low back pain A Cochrane Database of Systematic Reviews 2010, No. 7. Number: CD002014. doi: 10.1002 / 14651858.CD002014.pub3.

Evidence for treatment by injection.

A study of 366 participants from five high-quality studies found that protherapy injections alone were no more effective than control injections for long-term low back pain and disability, and that at 6 months, there was no difference between groups in mean pain or disability scores, and no difference in the proportion reporting a 50% or greater improvement in pain or disability.

However, they did find that long-term therapeutic injections combined with spinal manipulation and exercise, as well as other therapies, were more effective than control injections for chronic low back pain and disability.

Both of these studies reported significant differences in the percentage of individuals　who reported a 50% or greater reduction in disability or pain.

Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Pre-radiation therapy injections for chronic low back pain. Cochrane Database of Systematic Reviews, 2007, No. 2. Number: CD004059. doi: 10.1002 / 14651858.CD004059.pub3.

Evidence for nonsteroidal anti-inflammatory drugs.

A statistically significant effect favored NSAIDs compared with placebo, according to a study that included a total of 11,237 patients from 65 trials in its review. For acute low back pain, there is moderate evidence that NSAIDs are not more effective than paracetamol, but paracetamol has fewer side effects.

However, there is also moderate evidence that NSAIDs are no more effective than other drugs for acute low back pain. There is strong evidence that different types of NSAIDs are equally effective for acute low back pain, and there are reports that COX-2 NSAIDs have statistically significantly fewer side effects than conventional NSAIDs.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. nonsteroidal anti-inflammatory drugs for low back pain Cochrane Database of Systematic Reviews 2008, No. 1. Number: CD000396. doi: 10.1002 / 14651858.CD000396.pub3

Evidence for Transcutaneous Electrical Stimulation

According to a review including 585 patients from four high quality RCTs, there is conflicting evidence on whether TENS is beneficial in reducing low back pain intensity and consistent evidence that it did not improve low back-specific functional status.

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) and placebo for chronic low back pain. Cochrane Database of Systematic Reviews 2008, No. 4. Number: CD003008. doi: 10.1002 / 14651858.CD003008.pub3.

Evidence for ultrasound therapy.

According to a study that reviewed seven small randomized controlled trials involving 362 participants with chronic LBP, there is moderate evidence that therapeutic ultrasound therapy improves back-specific function in the short term compared with placebo, with interventions resulting from six to 18 treatment sessions of varying intensity, performed in a secondary care facility in addition to exercise therapy, and most commonly applied therapeutic ultrasound.

However, there is also lower quality evidence that it is not superior to placebo for short-term pain improvement.

And in this review, there is also low quality evidence that spinal manipulation is better at reducing pain and dysfunction.

Ebadi S, Henschke N, Nakhostin Ansari N, Fallah E, van Tulder MW. ultrasound treatment for chronic low back pain Cochrane Database of Systematic Reviews 2014, No. 3. Number: CD009169. doi: 10.1002 / 14651858.CD009169.pub2.

Evidence for muscle relaxants.

According to a study that reviewed 30 trials, there was strong evidence that any of the muscle relaxants were more effective than placebo in patients with acute LBP with respect to short-term pain reduction. However, adverse events were reported to be significantly more predominant in patients taking muscle relaxants, especially those who suffered central nervous system adverse effects, with a relative risk of 1.50.

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for nonspecific low back pain. Cochrane Database of Systematic Reviews 2003, No. 2. Number: CD004252. doi: 10.1002 / 14651858.CD004252.

Evidence from physiotherapy.

A study that interviewed a total of 182 participants from 12 studies reported that physiotherapists and others were able to give patients mechanical explanations but not in a way that made them feel less anxious. This discrepancy is explained by the fact that the patients are worried that the treatment for their back pain is "not working", but the physical therapists focus on their own methods rather than on the patients.

The study explains that this is because physiotherapists tend to be trained to focus on the mechanics, so they need to focus on the psychological aspects of the intervention rather than the treatment itself.

Aoife Synnott aMary O'Keeffe aSamantha Bunzli bWim Dankaerts cPeter O'Sullivan bKieran O'Sullivan a

Evidence for Traction Therapy

A review of 2762 participants from 32 RCTs found that traction interventions made little difference to low back pain pain, functional status, overall improvement or return to work compared with placebo, sham traction or no treatment.

They also found little or no difference in pain intensity, functional status, or overall improvement with traction when the combination of physical therapy and traction was compared to physical therapy alone and when traction was compared to other treatments.

Wegner I, Widyahening IS, van Tulder MW, Blomberg SEI, de Vet HCW, BrønfortG, Bouter LM, van der Heijden GJ. Traction for low back pain with and without sciatica. Cochrane Database of Systematic Reviews 2013, No. 8. Number: CD003010. doi: 10.1002 / 14651858.CD003010.pub5. 

Evidence for neural reflex therapy.

According to a study in which a total of 125 subjects from three RCTs were randomized to a control group and 148 subjects received active NRT, individuals who received active NRT performed statistically significantly better than controls on measures of pain, mobility, disability, medication use, resource consumption, and cost.

However, there was no significant difference in measures of quality of life.

This can be considered a safe and effective intervention for the treatment of chronic, non-specific LBP, while the effectiveness for subacute LBP is less clear.

Urrútia G, Burton AK, MorralFernández A, Bonfill Cosp X, Zanoli G. Neuroreflex therapy for nonspecific low back pain. Cochrane Database of Systematic Reviews 2004, No. 2. Number: CD003009. doi: 10.1002 / 14651858.CD003009.pub2.