Dr Michelle Dickinson: nanotechnologist on the non-surgical treatments that work for lower back pain - The Sunday Session with Francesca Rudkin

Lower back pain is something most of us have experienced at some point. Whether it's from sitting too long, lifting something heavy, or just the wear and tear of daily life, it's a common issue. But with so many treatments available, which ones actually work? A team of researchers set out to answer this question in a massive study published in BMJ Evidence-Based Medicine.

Gathering data from hundreds of previous studies, the researchers analysed 301 randomized controlled trials, covering 56 different treatments for low back pain. These treatments ranged from exercise and spinal manipulations to medications like NSAIDs (non-steroidal anti-inflammatory drugs) and antidepressants. 

To make the study even more precise, they divided the results into two categories: 

• Acute low back pain (pain lasting less than 12 weeks).
• Chronic low back pain (pain lasting 12 weeks or more).

Then, they compared each treatment to a placebo to see if it actually provided pain relief. 

The good news is that some non-surgical treatments do work, though not as dramatically as you might hope. 

For acute low back pain, NSAIDs (like ibuprofen) were the only treatment found to be effective, with a small but measurable pain reduction. 

For chronic low back pain, five treatments stood out: 

• Exercise: Physical movement tailored to strengthen the back and improve flexibility.
• Spinal manipulative therapy: Techniques often used by chiropractors to adjust the spine.
• Taping: Using supportive tape to stabilize muscles and joints.
• Antidepressants: Certain medications that seem to reduce pain perception.
• TRPV1 agonists: A class of treatments that target pain receptors.

Each of these treatments provided modest pain relief, meaning they worked better than a placebo, but not by much. 

What Doesn't Work?  

Some common treatments, surprisingly, did not provide significant pain relief. 

For acute low back pain, these treatments were found not to be effective: 

• Exercise (which works better for chronic pain but not short-term pain).
• Glucocorticoid injections (steroid shots that are sometimes used for inflammation).
• Paracetamol (acetaminophen) (commonly recommended but found to be ineffective in this study). 

For chronic low back pain, these treatments failed to provide significant benefits:

• Antibiotics (sometimes prescribed for infections that might cause pain, but no clear benefit).
• Anaesthetics (numbing agents that didn’t prove effective for long-term relief).

Many treatments had inconclusive results, meaning there wasn’t enough strong evidence to say whether they truly help. These included: 

• Acupuncture
• Massage
• Heat therapy
• Laser therapy
• Electromagnetic therapy 

This doesn’t necessarily mean they don’t work, just that more high-quality research is needed. 

So, if you have low back pain and are looking for non-surgical options, the research suggests: 

• If your pain is short-term, NSAIDs may help.
• If your pain is chronic, consider exercise, spinal manipulative therapy, taping, antidepressants, or TRPV1 agonists.
• Some treatments commonly recommended (like paracetamol and steroids) might not be as effective as previously thought.
• Many alternative treatments show promise but need better studies to confirm their benefits. 

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