Cochrane Database Syst Rev

Non-drug treatments for low back pain: What works and what doesn’t?

May 5, 2025

Study details: This Cochrane Review synthesized evidence from 31 systematic reviews of 644 trials encompassing 97,183 adults with low back pain (LBP). Various non-pharmacological and non-surgical treatments were evaluated, including spinal manipulation, acupuncture, traction, and heated back wraps. Primary outcomes were pain intensity, function, and safety, with comparisons made against placebo/sham treatments or usual care at short-term follow-up (≤ three months).

Results: For acute/subacute LBP, spinal manipulation showed no significant improvement in function compared with placebo (standardized mean difference [SMD] 0.08, 95% confidence interval [CI] -0.37 to 0.21). In chronic LBP, acupuncture provided a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07), while traction showed no significant effect on pain intensity (mean difference [MD] -4, 95% CI -17.7 to 9.7). Exercise therapies for chronic LBP showed a small to medium reduction in pain intensity (MD -15.2, 95% CI -18.3 to -12.2) and a small improvement in function (MD -6.8, 95% CI -8.3 to -5.3) compared with no treatment/usual care.

Clinical impact: These findings suggest that while some non-pharmacological treatments, such as exercise and acupuncture, can provide modest benefits for chronic LBP, the effectiveness varies by intervention and condition. This evidence supports the use of tailored, multimodal approaches in managing LBP, aligning with guidelines from the American College of Physicians, which recommend non-pharmacologic treatments as first-line options for chronic LBP.

Source:

Rizzo RR, et al. (2025, March). Cochrane Database Syst Rev. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews. https://pubmed.ncbi.nlm.nih.gov/40139265/