Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
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Masumi G. Asahi
Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ Publication No. 16-EHC004- EF.
Low back pain (LBP) is one of the most frequently encountered conditions in clinical practice, with up to 84% of adults reporting having had LBP at some time in their lives. The Agency for Healthcare Research and Quality (AHRQ) published a report aimed to assess the benefits of different pharmacologic and noninvasive, nonpharmacologic interventions for adults with acute, subacute, or chronic LBP.
The AHRQ selected systematic reviews of randomized trials of pharmacologic interventions and nonpharmacologic interventions for patients with nonradicular or radicular LBP published before April 2015. Of the 2545 citations identified, 156 were included, most of which enrolled patients with pain symptoms of at least moderate intensity (defined as >5 on a 0- to 10-point scale). Excluded from the review were studies conducted among patients with LBP related to cancer, infection, inflammatory arthropathy, high-velocity trauma, fracture, or severe or progressive neurologic deficits.
Evidence suggested that nonsteroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, opioids, exercise, and superficial heat were more effective than placebo or no intervention, but acetaminophen and systemic corticosteroids were no more effective than placebo in the management of acute LBP. For nonradicular chronic LBP, the review found that various pharmacologic and nonpharmacologic interventions were effective. Effective nonpharmacologic interventions included acupuncture, spinal manipulation, and multidisciplinary rehabilitation. Effective pharmacologic interventions included NSAIDs, opioids, tramadol, duloxetine, and benzodiazepines. Few trials evaluated the effectiveness of treatments for radicular LBP, but available evidence found that benzodiazepines, corticosteroids, traction, and spinal manipulation were not effective or were associated with nonsignificant effects.
It should be noted that this report did not include the systematic review by Franke et al1 that formed the basis for the American Osteopathic Association's updated guidelines on osteopathic manipulative treatment (OMT) for patients with LBP.2 Franke et al's review showed that OMT has a significant effect on pain relief (mean difference, −12.91; 95% CI, −20.00 to −5.82) and functional status (standard mean difference, −0.36; 95% CI, −0.58 to −0.14) on patients with acute and chronic nonspecific LBP. The AHRQ should update their recommendations in light of this review and recommend OMT to manage symptoms in patients with LBP.
References
1. Franke H , FrankeJD, FryerG. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. doi:10.1186/1471-2474-15-286Search in Google Scholar PubMed PubMed Central
2. Task Force on the Low Back Pain Clinical Practice Guidelines. American Osteopathic Association Guidelines for Osteopathic Manipulative Treatment (OMT) for Patients with Low Back Pain. J Am Osteopath Assoc. 2016;116(8):536-549. doi:10.7556/jaoa.2016.107Search in Google Scholar PubMed
© 2017 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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- AOA COMMUNICATION
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- ORIGINAL CONTRIBUTION
- Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
- EVIDENCE-BASED CLINICAL REVIEW
- Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
- CLINICAL PRACTICE
- An Osteopathic Approach to Chronic Pain Management
- MEDICAL EDUCATION
- Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
- SPECIAL COMMUNICATION
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- Cost-Effective Management of Low Back and Joint Pain by Specialty
- Benefit of OMT in Patients Who Underwent Heart Surgery
- Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
- Effectiveness of OMT and OCMM for Temporomandibular Disorders
- Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
- The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
- CLINICAL IMAGES
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Articles in the same Issue
- EDITORIAL
- 10.7556/jaoa.2017.049
- LETTERS TO THE EDITOR
- Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy
- RESPONSE
- Response
- CORRECTION
- Correction
- AOA COMMUNICATION
- Official Call: 2017 Annual Business Meeting of the American Osteopathic Association
- ORIGINAL CONTRIBUTION
- Employer-Funded Complete Health Improvement Program: Preliminary Results of Biomarker Changes
- EVIDENCE-BASED CLINICAL REVIEW
- Vitamin D Deficiency, Its Role in Health and Disease, and Current Supplementation Recommendations
- CLINICAL PRACTICE
- An Osteopathic Approach to Chronic Pain Management
- MEDICAL EDUCATION
- Preparing Physicians for Rural-Based Primary Care Practice: A Preliminary Evaluation of Rural Training Initiatives at OSU-COM
- SPECIAL COMMUNICATION
- Introducing High School Students to Careers in Osteopathic Medicine
- THE SOMATIC CONNECTION
- Cardiorespiratory Benefit of Aerobic Exercise for Patients With Asthma
- Cost-Effective Management of Low Back and Joint Pain by Specialty
- Benefit of OMT in Patients Who Underwent Heart Surgery
- Addition of Osteopathic Visceral Manipulation to OMT for Low Back Pain Decreases Pain and Increases Quality of Life
- Effectiveness of OMT and OCMM for Temporomandibular Disorders
- Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
- The Fundamental Frequency: A New Approach to Concussion Diagnosis in Children
- CLINICAL IMAGES
- Pacemaker Twiddler Syndrome
- Retroperitoneal Fibrosis
