Only one in ten treatments for back pain work, a study suggests.
Experts found that only one treatment for acute back pain and five treatments for chronic – or long-term – back pain were “effective.”
These include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for short-term back pain.
For long-term back pain, treatments that were found to be effective were exercise, spinal manipulative therapy, taping, antidepressants, and drugs that target the transient receptor potential vanilloid 1 (TRPV1) pain receptor.
But even these were found to have "small" or "mild" reductions in pain compared to a placebo - or fake medicine that looks or feels like the real thing.
Researchers admit that they cannot strongly recommend any particular form of therapy because the potential benefits are minimal.
But there are also many treatments that they have dismissed as "ineffective" or unsafe.
And for those that do work, experts point out that they are slightly more effective than a placebo.
The results will be a blow to millions of Americans and Britons who suffer from back pain, which can often be devastating.
It is the most common form of pain experienced by adults, with low back pain affecting 8 in 10 Americans and 6 in 10 Britons.
However, there is usually no immediately identifiable cause.
Researchers, from the University of New South Wales in Australia, called for more research to find treatments for back pain.
"Our review found no reliable evidence of large effects for any of the included treatments," the author wrote. – reports GazetaExpress.
"While we would like to provide more confident recommendations on where to invest and where to withdraw from treatments, it is not possible at this time."
“There is a clear need for large, high-quality, placebo-controlled trials to reduce uncertainty in estimates of effectiveness for many non-surgical and non-interventional treatments.”
Writing in the journal BMJ, researchers reviewed 301 previous trials covering 56 non-surgical treatments for back pain in adults.
Patients reported pain intensity at the beginning of the trial and again after treatment.
The study authors write: “The best available evidence indicates that one in ten common non-surgical and non-interventional treatments for low back pain are effective, providing small analgesic effects beyond placebo.”
They also noted that exercise, paracetamol pain medications – Tylenol or Panadol – and corticosteroid injections “probably do not provide any difference in pain” for acute low back problems.
Antibiotics and anesthetics were also found to be "ineffective" for long-term low back problems.
The rest of the interventions studied had "uncertain evidence," prompting the authors to call for more studies to examine the "remaining uncertainty" around a range of back pain treatments.
While the evidence was judged to be uncertain, the available information suggested that some of these may be effective for acute back pain.
For example, the authors found that the certainty of the evidence for acupuncture was “low,” but the information available in the reviewed studies suggests that it may provide moderate pain reduction for short- and long-term back pain.
And while massage is said to have significant pain reductions, the evidence surrounding this claim is “very low.”
The Centers for Disease Control and Prevention (CDC) recommends the use of ice, heat, elevation, rest, immobilization, and exercise for pain management, along with NSAIDs and acetaminophen.
The UK's healthcare watchdog, the National Institute for Health and Care Excellence (Nice), says that the diagnosis of back pain encompasses a variety of symptoms, meaning that "one approach to treatment does not fit all."
Patients should be offered access to a wider range of treatments if initial approaches don't work, he adds.
Ash James, director of practice and development at the Association of Qualified Physiotherapy, said: "Back pain is complex, with many contributing factors, so no single treatment will work for everyone, all the time."
"Physiotherapists are skilled at identifying the underlying cause of pain and tailoring treatments to meet the unique needs of each individual."
"Through a person-centered approach, they can examine a wide range of factors that may contribute to discomfort, such as stress, fear of movement, poor sleep, smoking, obesity, work stress, and insufficient physical activity."
"Most cases of back pain, while uncomfortable, are not serious and, with the right advice and early intervention, usually resolve quickly."
The study researchers said there were several limitations, the most important being the small sample sizes in the included studies and the uncertain results. /Express newspaper/
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