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Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6.

Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

Author information

1
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Oshawa, ON, Canada.
2
Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
3
Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Oshawa, ON, Canada.
4
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
5
Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
6
Masters Program, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
7
Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, USA.
8
Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
9
Rehabilitation Research Centre, University of Alberta, Edmonton, AB, Canada.
10
Injury Prevention Centre and School of Public Health, University of Alberta, Edmonton, AB, Canada.
11
Department of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
12
Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, QC, Canada.
13
Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada.
14
Masters Program, University of Saskatchewan, Saskatoon, SK, Canada.

Abstract

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited.

SIGNIFICANCE:

Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.

PMID:
27712027
DOI:
10.1002/ejp.931
[Indexed for MEDLINE]

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