What are effective ways to manage lower back pain?
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Effective Ways to Manage Lower Back Pain
Exercise Interventions for Chronic Low Back Pain
Strength and Coordination Exercises
Exercise interventions, particularly strength/resistance and coordination/stabilization programs, have been shown to significantly reduce chronic low back pain. A systematic review and meta-analysis of randomized controlled trials found that these types of exercises were more effective than other treatments in reducing pain and improving function. Additionally, a Bayesian meta-regression analysis highlighted that stretching and strengthening exercises are particularly beneficial for improving pain and function in adults with chronic low back pain.
Pilates and Core-Based Exercises
Pilates and core-based exercises are among the most effective exercise interventions for reducing pain and disability in adults with chronic low back pain. A network meta-analysis revealed that Pilates had the highest likelihood of reducing both pain and disability, followed by core-based and strength exercises. These exercises typically involve sessions of less than 60 minutes, conducted 1-2 times per week over a period of 3 to 9 weeks.
Nonpharmacologic Treatments
Superficial Heat, Massage, and Acupuncture
For acute or subacute low back pain, nonpharmacologic treatments such as superficial heat, massage, acupuncture, and spinal manipulation are recommended. These treatments have been found to be effective in reducing pain and improving function.
Multidisciplinary Rehabilitation and Mindfulness-Based Stress Reduction
For chronic low back pain, multidisciplinary rehabilitation, which includes a combination of physical and psychological therapies, is recommended. Mindfulness-based stress reduction, tai chi, yoga, and cognitive behavioral therapy are also effective nonpharmacologic treatments for managing chronic low back pain.
Behavioral Treatments
Operant and Cognitive Behavioral Therapy
Behavioral treatments, including operant and cognitive behavioral therapy, are commonly used to manage chronic low back pain by modifying maladaptive pain behaviors and cognitive processes. These therapies have been found to be more effective than usual care for short-term pain relief, although no specific type of behavioral therapy has been shown to be superior to others.
Meditation-Based Therapies
Meditation and Mind-Body Interventions
Meditation-based therapies, such as mindfulness meditation, have been shown to significantly reduce pain intensity and improve quality of life in patients with chronic low back pain. A systematic review and meta-analysis of randomized controlled trials found that meditation-based therapies are a safe and effective alternative for managing chronic low back pain.
Pharmacologic Treatments
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Muscle Relaxants
For patients who require pharmacologic treatment, nonsteroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants are recommended as first-line therapies. These medications have been found to be effective in reducing pain and improving function in patients with low back pain.
Tramadol and Duloxetine
For patients with chronic low back pain who do not respond to nonpharmacologic treatments, tramadol and duloxetine can be considered as second-line therapies. Opioids should only be considered if other treatments have failed and if the potential benefits outweigh the risks.
Conclusion
Effective management of lower back pain involves a combination of exercise interventions, nonpharmacologic treatments, behavioral therapies, and, when necessary, pharmacologic treatments. Strength and coordination exercises, Pilates, and core-based exercises are particularly effective for reducing pain and disability. Nonpharmacologic treatments such as superficial heat, massage, acupuncture, and mindfulness-based stress reduction also play a crucial role in managing both acute and chronic low back pain. Behavioral treatments and meditation-based therapies offer additional benefits, particularly for chronic conditions. When pharmacologic treatment is required, NSAIDs and muscle relaxants are recommended as first-line therapies, with tramadol and duloxetine as second-line options.
Sources and full results
Most relevant research papers on this topic
Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.
Exercise therapy for treatment of non-specific low back pain.
Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain
Prevention and treatment of low back pain: evidence, challenges, and promising directions
Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials
Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain
Best exercise options for reducing pain and disability in adults with chronic low back pain: Pilates, strength, core-based and mind-body. A network meta-analysis.
Behavioural treatment for chronic low-back pain.
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