| Key Question | Intervention | Outcome | Strength of Evidence | Conclusion |
|---|---|---|---|---|
| Key Question 1. Pharmacological therapies | Acetaminophen | Acetaminophen vs. placebo, acute LBP: Pain and function | Low | One good-quality trial found no difference between acetaminophen vs. placebo in pain intensity or function through 3 weeks. |
| Acetaminophen vs. NSAID, acute LBP: Pain and global improvement | Insufficient | A systematic review found no difference between acetaminophen vs. NSAIDs in pain intensity (3 trials; pooled SMD, 0.21; 95% CI, −0.02 to 0.43) or likelihood of experiencing global improvement (3 trials; RR, 0.81; 95% CI, 0.58 to 1.14) at ≤3 weeks, although estimates favored NSAIDs. | ||
| Acetaminophen vs. placebo, chronic LBP | Insufficient | No study evaluated acetaminophen vs. placebo. | ||
| Acetaminophen vs. NSAID, chronic LBP | Insufficient | There was insufficient evidence from 1 trial to determine effects of acetaminophen vs. NSAIDs. | ||
| Acetaminophen vs. other interventions, acute LBP | Insufficient | There was insufficient evidence from 4 trials to determine effects of acetaminophen vs. other interventions. | ||
| Acetaminophen vs. placebo: Adverse events (serious adverse events) | Moderate | One trial found no difference between scheduled acetaminophen, as-needed acetaminophen, or placebo in risk of serious adverse events (~1% in each group). | ||
| Acetaminophen vs. NSAIDs: Adverse events | Moderate | A systematic review found that acetaminophen was associated with lower risk of side effects vs. NSAIDs. | ||
| Acetaminophen vs placebo, NSAID, or other intervention, radicular LBP | Insufficient | No study evaluated acetaminophen for radicular low back pain. | ||
| Key Question 1. Pharmacological therapies | NSAIDs | NSAIDs vs. placebo, acute LBP: Pain and function | Moderate for pain, low for function | A systematic review found NSAIDs to be associated with greater improvement in pain intensity vs. placebo (4 studies; WMD, −8.39; 95% CI, −12.68 to −4.10; chi-square, 3.47; p >0.1), but 4 trials found no clear effects on the likelihood of achieving significant pain relief. One subsequent trial also found lower pain intensity after the first dose vs. placebo. One trial found NSAIDs to be associated with better function vs. placebo. |
| NSAIDs vs. placebo, chronic LBP: Pain and function | Moderate for pain, low for function | A systematic review found NSAIDs to be associated with greater improvement in pain vs. placebo (4 trials; WMD, −12.40; 95% CI, −15.53 to −9.26; chi-square, 1.82; p >0.5); 2 trials found NSAIDs to be associated with greater improvement in function. | ||
| NSAIDs vs. placebo, radicular LBP: Pain | Low | A systematic review found no difference in pain intensity between NSAIDs vs. placebo (2 trials; WMD, −0.16; 95% CI, −11.92 to 11.59; chi-square, 7.25; p <0.01). | ||
| NSAID plus another intervention vs. other intervention alone | Insufficient | There was insufficient evidence from 2 trials of an NSAID plus another intervention vs. the other intervention alone to determine effectiveness. | ||
| NSAIDs vs. interventions other than acetaminophen and opioids | Insufficient | There was insufficient evidence from 2 trials to determine the effects of NSAIDs vs. interventions other than acetaminophen and opioids. | ||
| NSAID vs. NSAID, acute or chronic LBP: Pain | Moderate | A systematic review found that most trials of 1 NSAID vs. another found no differences in pain relief in patients with acute LBP (15 of 21 trials) or chronic LBP (6 of 6 trials). | ||
| NSAIDs vs. placebo: Adverse events | Moderate | A systematic review found NSAIDs to be associated with more side effects vs. placebo (10 trials; RR, 1.35; 95% CI, 1.09 to 1.68). | ||
| COX-2-selective NSAIDs vs. nonselective NSAIDs: Adverse events | Moderate | COX-2-selective NSAIDs were associated with lower risk of side effects vs. nonselective NSAIDs (4 trials; RR, 0.83; 95% CI, 0.70 to 0.99). | ||
| Key Question 1. Pharmacological therapies | Opioids, tramadol, and tapentadol | Opioids vs. placebo, chronic LBP: Pain and function | Moderate | A systematic review found opioids to be associated with greater short-term improvement vs. placebo in pain scores (6 trials; SMD, −0.43; 95% CI, −0.52 to −0.33; I2 = 0.0%, for a mean difference of ~1 point on a 0–10 pain scale) and function (4 trials; SMD, −0.26; 95% CI, −0.37 to −0.15; I2 = 0.0%, for a mean difference of ~1 point on the RDQ); 3 additional trials reported results consistent with the systematic review. |
| Tramadol vs. placebo, chronic LBP: Pain and function | Moderate | A systematic review found tramadol to be associated with greater short-term pain relief vs. placebo (5 trials; SMD, −0.55; 95% CI, −0.66 to −0.44; I2 = 86%, for a mean difference of 1 point or less on a 0–10 pain scale) and function (5 trials; SMD, −0.18; 95% CI, −0.29 to −0.07; I2 = 0%, for a mean difference of ~1 point on the RDQ); 2 trials not included in the systematic review reported results consistent with the systematic review findings. | ||
| Buprenorphine patch vs. placebo, subacute or chronic LBP: Pain and function | Low for pain, insufficient for function | A systematic review included 2 trials that found buprenorphine patches to be associated with greater short-term improvement in pain vs. placebo patches; effects on function showed no clear effect or were unclearly reported. | ||
| Opioids vs. NSAIDs, chronic LBP: Pain relief, function | Insufficient | Three trials reported inconsistent effects of opioids vs. NSAIDs for pain relief; 1 trial found no difference in function. | ||
| Opioids vs. acetaminophen, acute LBP: Days to return to work, pain | Insufficient | One trial found no significant differences between opioids vs. acetaminophen in days to return to work; pain was not reported. | ||
| Long acting opioids vs. long-acting opioids: Pain and function | Moderate | Four trials found no clear differences among different long-acting opioids in pain or function. | ||
| LongL-acting opioids vs. short-acting opioids: Pain | Low | Six trials found no clear differences between long-acting vs. short-acting opioids in pain relief. Although some trials found long-acting opioids to be associated with greater pain relief, patients randomized to long-acting opioids also received higher doses of opioids. | ||
| Opioids vs. placebo: Adverse events | Moderate | Short-term use of opioids was associated with higher risk vs. placebo of nausea, dizziness, constipation, vomiting, somnolence, and dry mouth; risks of opioids were higher in trials that did not use an enriched enrollment and withdrawal design. | ||
| Key Question 1. Pharmacological therapies | Skeletal muscle relaxants | SMRs vs. placebo, acute LBP: Pain | Moderate | A systematic review found SMRs to be superior to placebo for short-term pain relief (≥2-point or 30% improvement on a 0–10 VAS pain scale) after 2 to 4 days (4 trials; RR, 1.25; 95% CI, 1.12 to 1.41; I2 = 0%) and 5 to 7 days (3 trials; RR, 1.72; 95% CI, 1.32 to 2.22; I2 = 0%); a more recent large (n = 562) trial was consistent with the systematic review. |
| SMR plus NSAID vs. NSAID alone, acute LBP: Pain | Low | A systematic review found no difference between an SMR plus an NSAID vs. the NSAID alone in the likelihood of experiencing pain relief, although the estimate favored combination therapy (2 trials; RR, 1.56; 95% CI, 0.92 to 2.70; I2 = 84%); 1 other trial (n = 197) also reported results that favored combination therapy. | ||
| SMR vs. placebo, chronic LBP: Pain | Insufficient | Evidence from 3 placebo-controlled trials was insufficient to determine effects due to imprecision and inconsistent results. | ||
| SMR vs. SMR, acute or chronic LBP: Pain | Low | Three trials in a systematic review found no differences in any outcome among different SMRs for acute or chronic low back pain. | ||
| SMR vs. placebo, acute LBP: Adverse events | Moderate | A systematic review found skeletal muscle relaxants for acute LBP to be associated with increased risk of any adverse event vs. placebo (8 trials; RR, 1.50; 95% CI, 1.14 to 1.98) and increased risk of central nervous system events, primarily sedation (8 trials; RR, 2.04; 95% CI, 1.23 to 3.37; I2 = 50%); 1 additional placebo-controlled trial was consistent with these findings. | ||
| Key Question 1. Pharmacological therapies | Benzodiazepines | Benzodiazepines vs. placebo, acute LBP: Pain and function | Insufficient | There was insufficient evidence from 2 trials with inconsistent results to determine effectiveness of benzodiazepines vs. placebo. |
| Tetrazepam vs. placebo, chronic LBP: Pain, overall improvement | Low | A systematic review included 2 trials that found tetrazepam to be associated with lower likelihood of no improvement in pain at 5–7 days (RR, 0.82; 95% CI, 0.72 to 0.94) and at 10–14 days (RR, 0.71; 95% CI, 0.54 to 0.93) vs. placebo, and lower likelihood of no overall improvement at 10–14 days (RR, 0.63; 95% CI, 0.42 to 0.97). | ||
| Diazepam vs. placebo, acute or subacute radicular pain: Pain and function | Low | One trial found no difference between diazepam 5 mg twice daily for 5 days vs. placebo in function at 1 week through 1 year or in other outcomes, including analgesic use, return to work, or likelihood of surgery through 1 year of followup. Diazepam was associated with lower likelihood of experiencing ≥50% improvement in pain at 1 week (41% vs. 79%; RR, 0.5; 95% CI, 0.3 to 0.8). | ||
| Benzodiazepines vs. SMRs, chronic LBP: Pain and function | Insufficient | There was insufficient evidence from 2 trials with inconsistent results to determine effects of benzodiazepines vs. SMRs. | ||
| Diazepam vs. cyclobenzaprine, chronic LBP: Muscle spasms | Low | One trial found no difference between diazepam vs. cyclobenzaprine in outcomes related to muscle spasm. | ||
| Benzodiazepines vs. placebo: Adverse events | Low | A systematic review found that central nervous system adverse events such as somnolence, fatigue, and lightheadedness were reported more frequently with benzodiazepines vs. placebo, although harms were not reported well; no trial was designed to evaluate risks with long-term use of benzodiazepines such as addiction, abuse, or overdose. | ||
| Key Question 1. Pharmacological therapies | Antidepressants | Tricyclic antidepressants or SSRIs vs. placebo, chronic LBP: Pain and function | Moderate for pain, low for function | A systematic review found no differences in pain between tricyclic antidepressants vs. placebo (4 trials; SMD, −0.10; 95% CI, −0.51 to 0.31; I2 = 32%) or SSRIs vs. placebo (3 trials; SMD, 0.11; 95% CI, −0.17 to 0.39; I2 = 0%); there was also no difference between antidepressants vs. placebo in function (2 trials; SMD, −0.06; 95% CI, −0.40 to 0.29; I2 = 0%). |
| Duloxetine vs. placebo, chronic LBP: Pain and function | Moderate | Three trials found duloxetine to be associated with lower pain intensity (differences, 0.58 to 0.74 on a 0 to 10 scale) and better function (differences, 0.58 to 0.74 on the Brief Pain Inventory-Interference scale) vs. placebo. | ||
| Duloxetine vs. tricyclic antidepressants | Insufficient | No study compared duloxetine vs. a tricyclic antidepressant. | ||
| Antidepressants vs. placebo: Adverse events, serious adverse events | Moderate | Antidepressants were associated with higher risk of any adverse events compared with placebo, with no difference in risk of serious adverse events. | ||
| Key Question 1. Pharmacological therapies | Antiseizure medications | Antiseizure medications, acute nonradicular LBP | Insufficient | No trial evaluated antiseizure medications for acute nonradicular LBP. |
| Gabapentin vs. placebo, chronic nonradicular LBP | Insufficient | One trial found no difference between gabapentin (up to 3600 mg/day) vs. placebo but did not meet inclusion criteria because it was published only as an abstract. | ||
| Gabapentin vs. placebo, chronic radicular LBP: Pain and function | Insufficient | There was insufficient evidence from 3 poor-quality trials with inconsistent findings to determine effects of gabapentin vs. placebo. | ||
| Topiramate vs. placebo, chronic radicular or mixed radicular and nonradicular LBP: Pain | Insufficient | Two trials reported inconsistent results for effects of topiramate vs. placebo. | ||
| Pregabalin vs. placebo, chronic radicular LBP: Pain and function | Insufficient | Two trials reported inconsistent effects of pregabalin vs. placebo for pain or function. | ||
| Pregabalin vs. amitriptyline: Pain | Insufficient | There was insufficient evidence from 1 poor-quality trial to determine effects of pregabalin vs. amitriptyline. | ||
| Pregabalin plus transdermal buprenorphine vs. transdermal buprenorphine, chronic nonradicular LBP: Pain | Insufficient | One small trial found that the addition of pregabalin 300 mg/day to transdermal buprenorphine was associated with substantially lower pain scores than transdermal buprenorphine alone at 3 weeks (difference, ~26 points on a 0 to 100 scale; p <0.05), but the estimate was very imprecise. | ||
| Pregabalin plus another analgesic vs. the other analgesic alone: Pain | Insufficient | One trial found pregabalin (mean, 2.1 mg/kg/day) plus celecoxib to be associated with lower pain scores than celecoxib alone (difference, 11 points on a 0–100 scale; p = 0.001) after 4 weeks, and 1 trial found no effects of adding pregabalin (titrated to 300 mg/day) to tapentadol prolonged release vs. tapentadol prolonged release alone on pain or the SF-12 after 8 weeks. | ||
| Gabapentin vs. placebo: Adverse events | Low | Two trials of gabapentin vs. placebo reported no clear differences in risk of adverse events. | ||
| Topiramate vs. placebo: Withdrawal due to adverse events, sedation, diarrhea | Insufficient | Two trials of topiramate vs. placebo reported inconsistent effects on risk of withdrawal due to adverse events; 1 of the trials found topiramate to be associated with higher risk of sedation and diarrhea. | ||
| Pregabalin vs. placebo: Withdrawal due to adverse events, somnolence, dizziness | Insufficient | Two trials of pregabalin vs. placebo reported inconsistent effects on risk of withdrawal due to adverse events, somnolence, and dizziness; 1 of the trials used an enrichment/withdrawal design. | ||
| Key Question 1. Pharmacological therapies | Corticosteroids | Systemic corticosteroids vs. placebo, acute nonradicular LBP: Pain and function | Low | Two trials found no differences between a single intramuscular injection or a 5-day course of systemic corticosteroids vs. placebo for pain or function. |
| Systemic corticosteroids vs. placebo, radicular LBP: Pain and function | Moderate | Five trials consistently found no differences between systemic corticosteroids (administered as a single bolus or as a short taper) vs. placebo in pain or function for acute or unspecified-duration LBP; 1 trial found no effect on need for spine surgery. | ||
| Systemic corticosteroids vs. placebo, spinal stenosis: Pain and function | Low | One trial found no differences through 12 weeks of followup between a 3-week course of prednisone vs. placebo in pain intensity, the RDQ, or any SF-36 subscale. | ||
| Systemic corticosteroids: Adverse events | Low | Trials of systemic corticosteroids did not report serious adverse events, including hyperglycemia requiring medical treatment, but adverse events were not reported well in some trials. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Exercise | Exercise vs. no exercise, acute to subacute LBP: Pain and function | Low | A systematic review found no differences between exercise therapy vs. no exercise in pain (3 trials; WMD, 0.59 at intermediate term on a 0 to 100 scale; 95% CI, −11.51 to 12.69) or function (3 trials; WMD at short term, −2.82; 95% CI, −15.35 to 9.71; WMD at intermediate term, 2.47; 95% CI, −0.26 to 5.21). For subacute LBP, there were also no differences in pain (5 trials; WMD, 1.89 on a 100-point scale; 95% CI, −1.13 to 4.91) or function (4 trials; WMD, 1.07; 95% CI, −3.18 to 5.32). Three subsequent trials for acute to subacute LBP reported inconsistent effects of exercise vs. usual care on pain and function. |
| Exercise vs. no exercise, chronic LBP: Pain and function | Moderate | A systematic review found exercise to be associated with greater pain relief vs. no exercise (19 trials; WMD, 10 on a 0 to 100 scale; 95% CI, 1.31 to 19.09), although the effect on function was small and not statistically significant (17 trials; WMD, 3.00 on a 0 to 100 scale; 95% CI, −0.53 to 6.48). Results from a more recent systematic review using more restrictive criteria and from additional trials not included in the systematic reviews were generally consistent with these findings. | ||
| MCE vs. minimal intervention, chronic LBP: Pain and function | Low | A systematic review included 2 trials that found MCE to be associated with lower pain scores in the short term (WMD, −12.48 on a 0 to 100 scale; 95% CI, −19.04 to −5.93), intermediate term (WMD, −10.18; 95% CI, −16.64 to −3.72), and long term (WMD, −13.32; 95% CI, −19.75 to −6.90) vs. a minimal intervention. MCE was also associated with better function at short term (3 trials; WMD, −9.00 on 0 to 100 scale; 95% CI, −15.28 to −2.73), intermediate term (2 trials; WMD, −5.62; 95% CI, −10.46 to −0.77), and long term (2 trials; WMD, −6.64; 95% CI, −11.72 to −1.57). | ||
| Exercise vs. usual care, nonacute LBP: Work disability | Moderate | A systematic review found no clear effects of exercise therapy versus usual care on likelihood of short- or intermediate-term (~6 months) disability, but exercise was associated with lower likelihood of work disability at long term (~12 months) followup (10 comparisons in 8 trials; OR, 0.66; 95% CI, 0.48 to 0.92). | ||
| Exercise vs. usual care, radicular LBP: Pain and function | Low | Three trials not included in the systematic reviews found effects that favored exercise vs. usual care or no exercise in pain and function, although effects were small. | ||
| MCE vs. general exercise, chronic LBP: Pain and function | Low | A systematic review found MCE to be associated with lower pain intensity at short term (6 trials; WMD, −7.80 on 0 to 100 scale; 95% CI, −10.95 to −4.65) and intermediate term (3 trials; WMD, −6.06; 95% CI, −10.94 to −1.18) vs. general exercise, but effects were smaller and no longer statistically significant at long term (4 trials; WMD, −3.10; 95% CI, −7.03 to 0.83). MCE was also associated with better function in the short term (6 trials; WMD, −4.65 on 0 to 100 scale; 95% CI, −6.20 to −3.11) and long term (3 trials; WMD, −4.72; 95% CI, −8.81 to −0.63). One of 2 subsequent trials found no effect on pain, although effects on function were consistent with the systematic review. | ||
| Exercise vs. exercise, acute or chronic LBP | Moderate | For comparisons involving other types of exercise techniques, there were no clear differences in >20 head-to-head trials of patients with acute or chronic LBP. | ||
| Exercise: Adverse events | Low | Harms were poorly reported in trials of exercise. When reported, harms were typically related to muscle soreness and increased pain, or no harms were reported; no serious harms were reported. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Pilates | Pilates vs. usual care plus physical activity, chronic LBP: Pain and function | Low | A systematic review included 7 trials that found Pilates to be associated with small (mean difference, −1.6 to −4.1 points) or no clear effects on pain at the end of treatment vs. usual care plus physical activity and no clear effects on function. |
| Pilates vs. other exercise, chronic LBP: Pain and function | Low | Three trials found no clear differences between Pilates vs. other types of exercise in pain or function. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Tai chi | Tai chi vs. wait list or no tai chi, chronic LBP: Pain and function | Low | Two trials found tai chi to be associated with improved pain-related outcomes vs. wait list or no tai chi (mean differences, 0.9 and 1.3 on a 0 to 10 scale); 1 trial also found tai chi to be associated with better function (mean difference, 2.6 on the RDQ; 95% CI, 1.1 to 3.7). |
| Tai chi vs. other exercise, chronic LBP: Pain | Low | One trial found tai chi to be associated with lower pain intensity vs. backward walking or jogging through 6 months (mean differences, −0.7 and −0.8), but there were no differences vs. swimming. | ||
| Tai chi: Adverse events | Low | One trial of tai chi reported a small temporary increase in back pain symptoms, and 1 trial reported no harms. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Yoga | Yoga vs. usual care, chronic LBP: Pain and function | Low | One trial found Iyengar yoga to be associated with lower pain scores (24 vs. 37 on a 0–100 VAS; p <0.001) and better function (18 vs. 21 on the 0 to 100 ODI; p <0.01, on a 0 to 100 scale) vs. usual care at 24 weeks. |
| Yoga vs. exercise, chronic LBP: Pain and function | Low | A systematic review found yoga to be associated with lower pain intensity and better function vs. exercise in most trials, although effects were small and differences were not always statistically significant (5 trials). | ||
| Yoga vs. education, chronic LBP: Pain and function | Moderate | Yoga was associated with lower short-term pain intensity vs. education (5 trials; SMD, −0.45; 95% CI, −0.63 to −0.26; I2 = 0%), but effects were smaller and not statistically significant at long term followup (4 trials; SMD, −0.28; 95% CI, −0.58 to −0.02; I2 = 47%); yoga was also associated with better function at short-term (5 trials; SMD, 0.45; 95% CI, −0.65 to −0.25; I2 = 8%) and long-term followup (4 trials; SMD, 0.39; 95% CI, −0.66 to −0.11; I2 = 40%). | ||
| Yoga: Adverse events | Low | Reporting of harms was suboptimal, but adverse events, when reported, were almost all classified as mild to moderate. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Psychological therapies | Progressive relaxation vs. wait-list control, chronic LBP: Pain and function | Low | A systematic review found progressive relaxation superior to wait-list control for post-treatment pain intensity (3 trials; mean difference, −19.77 on 0 to 100 VAS; 95% CI, −34 to −5.20; I2 = 57%) and functional status (3 trials; SMD, −0.88; 95% CI, −1.36 to −0.39; I2 = 0%). |
| EMG biofeedback, chronic LBP: Pain and function | Low | A systematic review found EMG biofeedback to be associated with lower pain intensity at the end of treatment (3 trials; SMD, −0.80; 95% CI, −1.32 to −0.28; I2 = 0%), with no clear effect on function (3 trials). | ||
| Operant therapy, chronic LBP: Pain and function | Low | A systematic review found operant therapy to be associated with lower pain intensity at the end of treatment (3 trials; SMD, −0.43; 95% CI, −0.75 to −0.1; I2 = 0%), with no clear effect on function (2 trials). | ||
| Cognitive therapy vs. wait-list control, chronic LBP | Insufficient | There was insufficient evidence from 2 trials to determine effects of cognitive therapy vs. wait-list control due to inconsistency and imprecision. | ||
| Cognitive-behavioral and other combined therapy vs. wait-list control, chronic LBP: Pain and function | Low | A systematic review found cognitive-behavioral and other combined psychological therapy to be associated with greater improvements in post-treatment pain intensity compared with wait-list control (5 trials; SMD, −0.60; 95% CI, −0.97 to −0.22; I2 = 40%), but effects on function were smaller and not statistically significant (4 trials; SMD, −0.37; 95% CI, −0.87 to 0.13; I2 = 50%). | ||
| Psychological therapies vs. exercise or physical therapy, chronic LBP: Pain and function | Low | A systematic review found no clear differences between psychological therapies vs. exercise therapy in pain intensity (2 trials) or between psychological therapies plus physiotherapy vs. physiotherapy alone (6 trials) in pain or function, although 1 small subsequent trial found combination therapy to be associated with greater improvements in pain and function immediately after treatment. | ||
| Psychological therapies vs. psychological therapies: Pain and function | Moderate | Ten trials found no clear differences among different psychological therapies in pain or function. | ||
| Psychological therapies: Adverse events | Low | Harms were not well reported, but no included trial reported any adverse events associated with psychological therapies. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Multidisciplinary rehabilitation | Multidisciplinary rehabilitation vs. usual care, chronic LBP: Pain, function, return to work | Moderate | A systematic review found multidisciplinary rehabilitation, compared with usual care, to be associated with lower short-term pain intensity (9 trials; SMD, −0.55; 95% CI, −0.83 to −0.28; I2 = 72%, or ~1.4-point mean difference on a 0 to 10 point numeric rating scale) and disability (9 trials; SMD, −0.41; 95% CI, −0.62 to −0.19; I2 = 58%, or ~2.5-point mean difference on the RDQ); effects on long-term pain intensity and disability also favored multidisciplinary rehabilitation but were smaller (7 trials; SMD, −0.21; 95% CI, −0.37 to −0.04; I2 = 25% and 6 trials; SMD,−0.23; 95% CI, −0.40 to −0.06; I2 = 19%, respectively), with no difference in likelihood of return to work (7 trials; OR, 1.04; 95% CI, 0.73 to 1.47; I2 = 31%). |
| Multidisciplinary rehabilitation vs. no multidisciplinary rehabilitation, chronic LBP: Pain and function | Low | A systematic review found multidisciplinary rehabilitation, compared with no multidisciplinary rehabilitation, to be associated with lower short-term pain intensity (3 trials; SMD, −0.73; 95% CI, −1.22 to −0.24; I2 = 64%, or ~1.7-point mean difference on a 0 to 10 numeric rating scale) and disability (3 trials; pooled SMD, −0.49; 95% CI, −0.76 to −0.22; I2 = 0%, or ~2.9-point mean difference on the RDQ); there was insufficient evidence to assess effects on long-term outcomes. | ||
| Multidisciplinary rehabilitation vs. physical therapy, chronic LBP: Pain and function | Moderate | A systematic review found multidisciplinary rehabilitation, compared with nonmultidisciplinary physical therapy, to be associated with lower short-term pain intensity (12 trials; SMD, −0.30; 95% CI, −0.54 to −0.06; I2 = 80%, or an approximate 0.6-point mean difference on a 0 to 10 point numeric rating scale) and disability (13 trials; SMD, −0.39; 95% CI, −0.68 to −0.10; I2 = 88%, or an approximate 1.2-point mean difference on the RDQ); multidisciplinary rehabilitation was also associated with lower long-term pain intensity (9 trials; SMD, −0.51; 95% CI, −1.04 to 0.01; I2 = 92%) and function (10 trials; SMD, −0.68; 95% CI, −1.19 to −0.16; I2 = 94%) and greater likelihood for return to work (8 trials; OR, 1.87; 95% CI, 1.39 to 2.53; I2 = 0%). | ||
| Multidisciplinary rehabilitation, acute LBP, radicular LBP | Insufficient | No study evaluated the effectiveness of multidisciplinary rehabilitation for acute LBP or for radicular LBP. | ||
| Multidisciplinary rehabilitation: Adverse events | Low | Harms were poorly reported in trials of multidisciplinary rehabilitation, although no serious harms were reported. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Acupuncture | Acupuncture vs. sham acupuncture, subacute LBP: Pain | Low | A systematic review found acupuncture to be associated with lower pain intensity vs. sham acupuncture using nonpenetrating needles (2 trials; mean difference, 9.38 on a 0 to 100 VAS; 95% CI, 1.76 to 17.0; I2 = 27%); 3 other trials reported effects consistent with these findings. One trial of sham acupuncture using penetrating needles to nonacupuncture points found no effect on pain. There were no clear effects on function in 5 trials. |
| Acupuncture vs. sham acupuncture, chronic LBP: Pain and function | Moderate | A systematic review found acupuncture to be associated with lower pain intensity vs. sham acupuncture (superficial needling at acupuncture or nonacupuncture points or nonpenetrating pressure at acupuncture points) immediately at the end of treatment (4 trials; WMD, −16.76; 95% CI, −33.3 to −0.19; I2 = 90%) and at up to 12 weeks (3 trials; WMD, −9.55; 95% CI, −16.5 to −2.58; I2 = 40%), but there were no differences in function. Four additional trials reported results consistent with these findings. | ||
| Acupuncture vs. no acupuncture, chronic LBP | Moderate | A systematic review found acupuncture to be associated with lower pain intensity (4 trials; SMD, −0.72; 95% CI, −0.94 to −0.49; I2 = 51%) and better function (3 trials; SMD, −0.94; 95% CI, −1.41 to −0.47; I2 = 78%) immediately after treatment vs. no acupuncture. Mean effects on pain ranged from 7 to 24 points on a 0 to 100 point scale; for function, 1 trial reported a difference of 8 points on a 0 to 100 scale and the other 2 trials showed small or no clear differences at long-term followup. | ||
| Acupuncture vs. NSAIDs, acute LBP: Overall improvement | Low | A systematic review found acupuncture to be associated with slightly greater likelihood of overall improvement vs. NSAIDs at the end of treatment (5 trials; RR, 1.11; 95% CI, 1.06 to 1.16; I2 = 0%). | ||
| Acupuncture vs. medications (NSAIDs, muscle relaxants and analgesics), chronic LBP: Pain and function | Low | A systematic review found acupuncture to be associated with better pain relief (3 trials; WMD, −10.56 on a 0 to 100 scale; 95% CI, −20.34 to −0.78; I 2 = 0%) and improvement in function (3 trials; SMD, −0.36; 95% CI, −0.67 to −0.04; I2 = 7%) immediately postintervention. | ||
| Acupuncture: Adverse events | Low | Harms of acupuncture were poorly reported in the trials, although no serious adverse events were reported. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Massage | Massage vs. sham massage, acute LBP: Pain and function | Low | A systematic review included 2 trials that found massage to be associated with greater short-term (1 week) improvement in pain (SMD, −0.92; 95% CI, −1.35 to −0.48) and function (SMD, −1.76; 95% CI, −3.19 to −0.32) vs. sham therapy, but there was no difference in pain or function at 5 weeks in 1 trial. |
| Massage vs. usual care, chronic LBP: Pain and function | Low | One trial found no difference between foot reflexology vs. usual care in pain or function, and 1 trial found structural or relaxation massage to be associated with better function (mean, 2.5 to 2.9 points on the RDQ) vs. usual care at 10 weeks; effects were less pronounced at 52 weeks. | ||
| Massage vs. other interventions, subacute to chronic LBP: Pain and function | Moderate | A systematic review found massage to be associated with better effects on short-term pain in 7 of 9 trials (mean differences, −0.6 to −0.94 points on a 0 to 10 scale) and better effects on short-term function in 3 of 4 trials. | ||
| Massage plus another active intervention vs. the other intervention alone, subacute to chronic LBP: Pain and function | Low | A systematic review included 5 trials that generally found massage plus another intervention to be superior to the other intervention without massage for short-term pain, with effects somewhat stronger in trials in which massage was combined with exercise; few differences were observed for function or long-term pain. Two subsequent trials of massage plus exercise reported findings generally consistent with these findings. | ||
| Massage vs. massage: Pain and function | Insufficient | Comparisons of different massage techniques were too heterogeneous and effects were too small from 6 trials to determine effects on pain and function. | ||
| Massage: Adverse events | Low | Harms were not well reported in trials of massage, although no serious adverse events were reported; 2 trials reported soreness during or shortly after the treatment. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Spinal manipulation | Spinal manipulation, acute LBP: Pain and function | Low for function, insufficient for pain | Two trials (1 included in a systematic review) found spinal manipulation to be associated with better effects on function vs. sham manipulation (statistically significant in 1 trial); in 1 trial, effects on pain favored manipulation but were small and not statistically significant (mean difference, −0.50; 95% CI, −1.39 to 0.39). |
| Spinal manipulation vs. sham manipulation, chronic LBP: Pain and function | Low for pain, insufficient for function | A systematic review found spinal manipulation to be associated with small, statistically nonsignificant effects vs. sham manipulation on pain at 1 month (3 trials; WMD, −3.24; 95% CI, −13.62 to 7.15 on a 0 to 100 scale; I2 = 53%); 1 trial reported similar results for function (SMD, −0.45; 95% CI, −0.97 to 0.06); 1 trial not included in the systematic review reported generally consistent results. | ||
| Spinal manipulation vs. inert treatment, acute LBP: Pain and function | Low | A systematic review found no differences between spinal manipulation vs. inert treatment in pain relief at 1 week (3 trials; WMD, 0.14 on a 0 to 10 scale; 95% CI, −0.69 to 0.96; I2 = 27%), although 1 trial found spinal manipulation to be associated with better long term pain relief (mean difference, −1.20 at 3 months; 95% CI, 2.11 to −0.29); there were no differences in function at 1 week (2 trials; SMD, −0.08; 95% CI, −0.37 to 0.21; I2 = 0%) or at 3 months (1 trial; SMD, −0.28; 95% CI, −0.59 to 0.02). | ||
| Spinal manipulation vs. inert treatment, chronic LBP | Low | One trial with low risk of bias found spinal manipulation to be associated with greater improvement in the “main complaint” vs. an inert treatment (mean difference, 0.9 on a 0 to 10 scale; 95% CI, 0.1 to 1.7); results from 3 trials with high risk of bias and 3 additional trials not included in the systematic review were somewhat inconsistent, although some trials reported effects that favored manipulation. | ||
| Spinal manipulation vs. other active interventions, acute LBP: Pain and function | Moderate | A systematic review found no difference between spinal manipulation vs. other active interventions in pain relief at 1 week (3 trials; WMD, 0.06 on a 0 to 10 scale; 95% CI, −0.53 to 0.65; I2 = 0%), 1 month (3 trials; WMD, −0.15; 95% CI, −0.49 to 0.18; I2 = 0%), 3 to 6 months (2 trials; WMD, −0.20; 95% CI, −1.13 to 0.73; I2 = 81%), or 1 year (1 trial; mean difference, 0.40; 95% CI, −0.08 to 0.88). Findings were similar for function, with no differences observed at any timepoint. A subsequent trial of patients with acute or subacute LBP found that spinal manipulation was associated with moderate effects vs. usual care on pain and small effects on function at short-term followup, but effects were smaller and no longer statistically significant at 3 and 6 months | ||
| Spinal manipulation vs. other interventions, chronic LBP: Pain and function | Moderate | A systematic review found spinal manipulation to be associated with better short-term pain relief vs. other active interventions at 1 month (10 comparisons from 6 trials; WMD, −2.76 on a 0 to 100 scale; 95% CI, −5.19 to −0.32; I2 = 27%) and 6 months (7 comparisons from 4 trials; WMD, −3.07; 95% CI, −5.42 to −0.71; I2 = 0%), although the magnitude of effects was below the small/slight threshold. There was no difference at 12 months (3 trials; WMD, −0.76; 95% CI, −3.19 to 1.66; I2 = 0%). Manipulation was also associated with greater improvement in function vs. other active interventions at 1 month (10 comparisons from 6 trials; SMD, −0.17; 95% CI, −0.29 to −0.06; I2 = 3%); effects were smaller and no longer statistically significant at 6 and 12 months. Three trials not included in the systematic reviews reported results consistent with these findings. | ||
| Spinal manipulation plus exercise or advice vs. exercise or advice alone, acute LBP: Function | Low | Four trials in a systematic review found spinal manipulation plus either exercise or advice to be associated with greater improvement in function at 1 week (SMD, −0.41; 95% CI, −0.73 to −0.10; I2 = 18%) vs. exercise or advice alone, but there were no differences at 1 month (3 trials; SMD, −0.09; 95% CI, −0.39 to 0.21; I2 = 37%) or 3 months (2 trials; SMD, −0.22; 95% CI, −0.61 to 0.16; I2 = 41%). | ||
| Spinal manipulation plus another active treatment, chronic LBP: Pain and function | Low | A systematic review found spinal manipulation plus another active treatment to be associated with greater pain relief at 1 month (3 trials; WMD, −5.88 on a 0 to 100 scale; 95% CI, −10.85 to −0.90; I2 = 0%), 3 months (2 trials; mean difference, −7.23; 95% CI, −11.72 to −2.74; I2 = 43%), and 12 months (2 trials; mean difference, −3.31; 95% CI, −6.60 to −0.02; I2 = 12%) vs. the other treatment alone. Combination therapy was also associated with better function at 1 month, (2 trials; SMD, −0.40; 95% CI, −0.73 to −0.07; I2 = 0%), 3 months (2 trials; SMD, −0.22; 95% CI, −0.38 to −0.06; I2 = 33%), and 12 months (2 trials; SMD, −0.21; 95% CI, −0.34 to −0.09; I2 = 0%). One trial not included in the systematic review reported results consistent with these findings. | ||
| Spinal manipulation plus home exercise and advice, radicular LBP | Low | One good-quality trial found spinal manipulation plus home exercise and advice to be associated with greater improvement in leg and back pain at 12 weeks vs. home exercise and advice alone (mean differences about 1 point on a 0 to 10 scale), but effects were smaller (0.3 to 0.7 points) and no longer statistically significant at 52 weeks. | ||
| Spinal manipulation: Adverse events | Low | Harms were not reported well in most trials of spinal manipulation. No serious adverse events were reported, and most adverse events were related to muscle soreness or transient increases in pain. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Ultrasound | Ultrasound vs. sham ultrasound, chronic LBP: Pain and function | Low for pain, insufficient for function | A systematic review found no difference between ultrasound vs. sham ultrasound in pain at the end of treatment (3 trials; mean difference, −7.12 on 0 to 100 scale; 95% CI, −18.0 to 3.75; I2 = 77%), and 2 trials found no effects on pain 4 weeks after the end of treatment. Evidence from 5 trials was too inconsistent to determine effects on function, although a larger good-quality trial found no effect on the RDQ. |
| Ultrasound vs. no ultrasound, chronic LBP: Pain and function | Low | A systematic review found no differences between ultrasound vs. no ultrasound in pain (2 trials; mean difference, −2.16; 95% CI, −4.66 to 0.34; I2 = 0%) or back-specific function (2 trials; mean difference, −0.41; 95% CI, −3.14 to 2.32), but estimates were imprecise. | ||
| Ultrasound plus exercise vs. exercise, chronic LBP: Pain and function | Insufficient | Evidence from 3 trials was insufficient to determine effects of ultrasound plus exercise vs. exercise alone on pain or function due to imprecision and methodological shortcomings. | ||
| Ultrasound plus exercise vs. exercise, radicular LBP: Back pain, leg pain | Insufficient | A small trial found no differences between ultrasound plus exercise vs. sham ultrasound plus exercise in back pain, leg pain, or the ODI after 3 weeks of therapy. | ||
| Ultrasound vs. other interventions | Insufficient | There was insufficient evidence from 3 small trials with methodological shortcomings to determine effects of ultrasound vs. other interventions. | ||
| Ultrasound vs. other interventions, radiculopathy | Insufficient | There was insufficient evidence from 2 small trials with methodological shortcomings to determine effects of ultrasound vs. other interventions. | ||
| Ultrasound, acute nonradicular LBP | Insufficient | No study evaluated the effectiveness of ultrasound for acute nonradicular LBP. | ||
| Ultrasound vs. sham ultrasound: Adverse events | Low | One trial found no differences between ultrasound vs. sham ultrasound in risk of any adverse event (6.0% vs. 5.9%; RR, 1.03; 95% CI, 0.49 to 2.13) or serious adverse events (1.3% vs. 2.7%; RR, 0.48; 95% CI, 0.12 to 1.88). | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Transcutaneous electrical nerve stimulation | TENS vs. sham TENS, acute or subacute LBP: Pain and function | Insufficient | Evidence from single trials with methodological shortcomings was too limited to permit reliable conclusions regarding effectiveness. |
| TENS vs. sham TENS, chronic LBP: Pain and function | Low | A systematic review found no differences between TENS vs. sham TENS in pain intensity (4 trials; WMD, −4.47 on a 0 to 100 scale; 95% CI, −12.84 to 3.89) or function (2 trials; WMD, −1.36 on a 0 to 100 scale; 95% CI, −4.38 to 1.66) at short-term followup; most trials found no effect on pain or function at the end of a course of treatment. | ||
| TENS vs. acupuncture, chronic LBP: Pain | Low | A systematic review found no differences between TENS vs. acupuncture for short- (4 trials; SMD, 0.15; 95% CI, −0.33 to 0.63) or long-term pain (2 trials; SMD, 0.32; 95% CI, −0.33 to 0.96). Evidence for TENS vs. other interventions was too limited to permit reliable conclusions. | ||
| TENS: Adverse events | Low | Evidence on harms associated with TENS was limited but suggests an increased risk of skin-site reactions without an increased risk of serious adverse events. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Electrical muscle stimulation | EMS plus exercise vs. exercise, EMS vs. other interventions, acute or chronic LBP: Pain and function | Insufficient | There was insufficient evidence from 5 RCTs to determine effects of EMS plus exercise vs. exercise alone or vs. other interventions due to methodological limitations and imprecision. |
| EMS: Adverse events | Insufficient | There was insufficient evidence to determine harms of EMS. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Percutaneous electrical nerve stimulation | PENS vs. sham PENS, PENS plus exercise vs. exercise, PENS vs. other interventions, chronic LBP (with or without radiculopathy) | Insufficient | There was insufficient evidence from 7 trials to determine effects of PENS vs. sham, PENS plus exercise vs. exercise alone, or PENS vs. other interventions due to methodological limitations, inconsistency, and imprecision. |
| PENS: Adverse events | Insufficient | Harms were poorly reported in trials of PENS. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Interferential therapy | IFT vs. other interventions, IFT plus another intervention vs. the other intervention, subacute to chronic LBP: Pain and function | Insufficient | There was insufficient evidence from 4 trials to determine effects of IFT vs. other interventions or IFT plus another intervention vs. the other intervention alone, due to methodological limitations and imprecision. |
| IFT: Adverse events | Insufficient | No study evaluated harms of IFT. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Superficial heat or cold | Heat wrap vs. placebo, acute or subacute LBP: Pain and function | Moderate | A systematic review found a heat wrap to be more effective than placebo for pain relief at 5 days (2 trials; mean difference, 1.06 on a 0 to 5 scale; 95% CI, 0.68 to 1.45) and disability at 4 days (mean difference, −2.10 on the RDQ; 95% CI, −3.19 to −1.01). Two subsequent trials also found a heat wrap to be associated with decreased pain intensity at 3 to 4 days (differences, 16 to 20 points on a 0 to 100 point VAS) or increased pain relief at 8 hours (difference, ~1.5 points on a 0 to 5 scale). Another trial found a heat wrap during emergency transport to be associated with substantially lower pain intensity vs, an unheated blanket on arrival to the hospital. |
| Heat plus exercise vs. exercise alone, acute LBP: Pain and function | Low | One higher quality trial found heat plus exercise to be associated with greater pain relief (mean difference, 1.40 on 0 to 10 scale; 95% CI, 0.69 to 2.11) and higher function (mean RDQ difference, −3.20; 95% CI, −5.42 to −0) vs. exercise without heat at day 7. | ||
| Heat plus NSAID vs. NSAID alone, acute LBP: Pain | Insufficient | One fair-quality trial found heat plus an NSAID to be associated with better pain scores versus an NSAID without heat at day 15 based on the McGill Pain Questionnaire (scoring methods unclear). | ||
| Heat vs. simple analgesics, acute or subacute LBP: Pain and function | Low | A systematic review included 1 trial that found heat to be more effective for pain relief than acetaminophen (mean difference, 0.90 on a 0 to 10 scale; 95% CI, 0.50 to 1.30) or ibuprofen (0.65; 95% CI, 0.25 to 1.05) after 1 to 2 days of treatment; the heat wrap was also associated with greater improvement on the RDQ (mean differences, 2.00 on a 0 to 24 scale; 95% CI, 0.86 to 3.14, and 2.20; 95% CI, 1.11 to 3.29, respectively). | ||
| Heat vs. exercise, acute LBP: Pain and function | Low | A systematic review included 1 trial that found no clear differences between heat vs. exercise in pain relief or function. | ||
| Superficial cold vs. placebo | Insufficient | No study compared superficial cold vs. placebo or no cold treatment. | ||
| Cold plus naproxen vs. naproxen alone, acute LBP: Pain | Insufficient | One small trial with methodological shortcomings found cold plus naproxen to be associated with better pain scores vs. naproxen alone based on the McGill Pain Questionnaire (scoring methods unclear) | ||
| Heat vs. cold | Insufficient | There was insufficient evidence from 3 trials to determine effects of heat vs. cold due to methodological limitations and imprecision. | ||
| Heat vs. no heat or placebo: Adverse events, flushing | Low | Heat was not associated with increased risk of skin flushing vs. no heat or placebo in 2 trials; no serious adverse events were reported with use of heat. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Low- level laser therapy | LLLT vs. sham laser, acute LBP | Insufficient | There was insufficient evidence from 1 trial to determine effectiveness of LLLT vs. sham laser due to serious methodological shortcomings and imprecision. |
| LLLT vs. sham laser, chronic LBP: Pain and function | Low | Three of 4 trials found LLLT to be more effective than sham laser for pain, although methods for assessing pain and duration of followup varied; 2 trials found LLLT to be more effective than sham laser for function, with small magnitude of effect. | ||
| LLLT plus NSAID vs. sham plus NSAID, acute or subacute LBP: Pain and function | Low | One trial found LLLT plus an NSAID to be associated with lower pain intensity vs. sham laser plus an NSAID or the NSAID alone (mean differences, 9 to 14 points on a 0 to 100 VAS); effects on the ODI also favored combination treatment but were smaller (differences <6 points). | ||
| LLLT plus another intervention vs. the other intervention alone, chronic LBP: Pain and function | Insufficient | There was insufficient evidence from 3 trials to determine effects of LLLT plus exercise vs. sham laser plus exercise alone due to methodological shortcomings and inconsistency. | ||
| LLLT vs. another intervention: Pain and function | Insufficient | There was insufficient evidence to determine effects of LLLT vs. another intervention due to methodological shortcomings and imprecision. | ||
| LLLT, differing wavelengths or doses | Insufficient | There was insufficient evidence to determine effects of different wavelengths or doses of LLLT due to methodological limitations and imprecision. | ||
| LLLT: Adverse events | Low | Harms were not well reported in trials of LLLT, but no serious adverse events and no harms were reported. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Short-wave diathermy | Short-wave diathermy vs. sham diathermy, mixed-duration LBP: Effectiveness and adverse events | Insufficient | There was insufficient evidence from 5 RCTs to determine effects of short-wave diathermy vs. sham diathermy due to methodological limitations and imprecision. |
| Short-wave diathermy: Adverse events | Insufficient | No study evaluated harms of short-wave diathermy. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Lumbar supports | Lumbar supports vs. no lumbar supports or an inactive treatment, acute or subacute LBP: Pain and function | Insufficient | There was insufficient evidence from 5 trials to determine effects of lumbar supports vs. no lumbar supports or an inactive treatment due to methodological shortcomings and inconsistent results. |
| Lumbar supports vs. no lumbar supports, chronic LBP | Insufficient | There was insufficient evidence from 2 trials to determine effects of lumbar supports vs. no lumbar supports due to methodological shortcomings and inconsistent results. | ||
| Lumbar supports vs. no lumbar supports, mixed-duration LBP: Pain and function | Low | One trial found an inextensible, but not an extensible, lumbar supports to be associated with greater improvement in function vs. no lumbar support, but effects were small. There was no clear effect on function. | ||
| Lumbar support plus education vs. education, acute or subacute LBP: Pain and function | Low | One trial found no differences between a lumbar support plus an education program vs. an education program alone in pain or function after 1 year. | ||
| Lumbar support plus exercise vs. exercise alone, chronic LBP: Pain and function | Low | One trial found no difference between a lumbar support plus exercise (muscle strengthening) vs. exercise alone in short-term (8 week) or long-term (6 month) pain or function. | ||
| Lumbar support vs. other active treatments: Pain and function | Low | Three trials found no clear differences between lumbar supports vs. other active treatments in pain or function. | ||
| Lumbar supports vs. lumbar supports: Pain and function | Insufficient | There was insufficient evidence from 2 trials to determine comparative effects of different types of lumbar supports for chronic LBP or back pain of mixed duration due to heterogeneous comparisons, methodological shortcomings, and imprecision. | ||
| Lumbar supports: Adverse events | Low | Trials reported no harms associated with use of lumbar supports. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Traction | Traction vs. placebo, sham, or no treatment, LBP with or without radicular symptoms: Pain, function, other outcomes | Insufficient | A systematic review included 13 trials that found no clear differences and inconsistent effects of traction vs. placebo, sham, or no treatment in pain, function, or other outcomes, although 2 trials reported favorable effects on pain in patients with radicular back pain. |
| Traction vs. physiotherapy, LBP with or without radicular symptoms | Low | A systematic review included 5 trials that found no clear differences between traction plus physiotherapy vs. physiotherapy alone. | ||
| Traction vs. other interventions, LBP with or without radicular symptoms: Pain and function | Low | A systematic review included 15 trials of traction vs. other interventions that found no clear between traction vs. other active interventions in pain or function. | ||
| Traction vs. traction | Low | A systematic review included 5 trials that found no clear differences among different types of traction. | ||
| Traction: Adverse events | Low | Eleven trials of traction in a systematic review reported no adverse events or no difference in risk of adverse events vs. placebo or other interventions. Three subsequent trials reported findings consistent with the systematic review. | ||
| Key Question 2. Nonpharmacological noninvasive therapies | Taping | Kinesio Taping® vs. sham taping, chronic LBP: Pain and function | Insufficient for pain, low for function | Two trials found no differences between Kinesio Taping vs. sham taping in back-specific function after 5 to 12 weeks; effects on pain were inconsistent. |
| Functional Fascial Taping® plus exercise vs. sham taping plus exercise, chronic LBP: Pain and function | Insufficient | There was insufficient evidence from 1 trial to determine effects of Functional Fascial Taping plus exercise vs. sham taping plus exercise due to methodological limitations and imprecision. | ||
| Kinesio Taping vs. exercise therapy, chronic LBP: Pain and function | Low | Two trials found no differences between Kinesio Taping vs. exercise therapy in pain or function. | ||
| Taping: Adverse events | Insufficient | No trial of taping reported harms. |
From: Discussion
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