Certain nonsurgical interventions for chronic low back pain may offer sustained benefits

For individuals with chronic low back pain, nonsurgical interventions such as cognitive behavioural therapy (CBT), mindfulness, exercise, and multidisciplinary care can help reduce pain intensity and disability in the long term, according to a systematic review and meta-analysis.

Researchers searched multiple online databases for randomized controlled trials in which the efficacy of nonsurgical interventions was assessed in adults with non-specific chronic low back pain. Outcomes included pain intensity, disability, or both at long-term (1–2 years) and very long-term (≥2 years) follow-up. Comparators used were placebo, adjuvant intervention, no intervention, or usual care.

A total of 75 trials involving 15,395 participants were included in the meta-analysis. Fifty-one of these (68 percent) had a high risk of bias.

Pooled data showed a moderate certainty evidence that CBT could reduce pain intensity (mean difference, –7.2, 95 percent confidence interval [CI], –9.8 to –4.6; I²=0.0) and disability (mean difference, –5.7, 95 percent CI, –7.7 to –3.7; I²=0.0). Mindfulness was also found to be beneficial (pain intensity: mean difference, –10.0, 95 percent CI, –14.4 to –5.6; I²=0.1; disability: mean difference, –9.3, 95 percent CI, –14.4 to –4.1; I²=11.1).

Other interventions such as goal setting and needling helped reduce disability (mean difference, –8.3, 95 percent CI, –12.8 to –3.9; I²=4.8 and mean difference, –4.8, 95 percent CI, –8.1 to –1.5; I²=0.0, respectively).

There was low certainty evidence that multidisciplinary care might lessen pain intensity (mean difference, –10.1, 95 percent CI, –16.6 to –3.7; I² =0.0) at long-term follow-up, while exercise might reduce disability (mean difference, –10.2, 95 percent CI, –17.5 to –2.9; I²=33.5) at very long-term follow-up.

The researchers acknowledged the presence of heterogeneity in several of the meta-analyses and advised caution when interpreting the results.