A comprehensive evidence review has found that most treatments commonly recommended for low back pain provide minimal relief, with only non-steroidal anti-inflammatory drugs (NSAIDs) showing moderate effectiveness for short-term pain management.
Researchers from Neuroscience Research Australia analyzed findings from 301 clinical trials examining 56 different treatments for low back pain, revealing that only about 10% of these interventions had medical evidence supporting their effectiveness—and even those provided only modest benefits.
"Surprisingly, we found only around one in 10 was effective and most provided pain relief that was only marginally better than placebo," said Dr. Aidan Cashin, deputy director of the Center for Pain IMPACT at Neuroscience Research Australia.
Limited Evidence for Effectiveness
The review, published in BMJ Evidence-Based Medicine, evaluated non-surgical treatments typically considered first-line care for back pain. For acute low back pain, only NSAIDs like aspirin and ibuprofen demonstrated meaningful effectiveness based on available evidence.
For chronic low back pain, five treatments showed potential benefit, though with small effects:
- Exercise
- Spinal manipulation
- Taping
- Antidepressants
- TRPV1 agonists (warming creams containing ingredients like capsaicin)
The researchers also specifically identified treatments that evidence suggests are ineffective. For short-term low back pain, these included exercise, steroid injections, and acetaminophen. For chronic back pain, antibiotics and anesthetics showed no benefit.
For the majority of treatments evaluated in the research, there simply wasn't enough evidence to determine effectiveness one way or the other.
Epidural Steroid Injections Show Limited Benefit
A separate systematic review published in the journal Neurology by the American Academy of Neurology (AAN) specifically examined epidural steroid injections for chronic lower back pain.
This analysis of 90 studies conducted over 16 years found that these injections may provide modest benefits for specific conditions. For patients with radiculopathy (pinched nerve), the injections modestly reduced both pain and disability compared to no treatment. For those with spinal stenosis (compressed spinal cord or nerves), injections appeared to reduce disability but not pain.
"Our review affirms the limited effectiveness of epidural steroid injections in the short term for some forms of chronic back pain," said Dr. Pushpa Narayanaswami of Beth Israel Deaconess Medical Center in Boston, a co-author of the AAN study.
Implications for Clinical Practice
The findings highlight the challenges in effectively treating low back pain, a condition that significantly impacts quality of life for millions of people worldwide. Despite the wide range of available treatments, the evidence suggests most provide minimal relief.
Dr. Cashin emphasized the need for further research: "We need further high-quality, placebo-controlled trials to understand the efficacy of treatments and remove the uncertainty for both patients and clinical teams."
In the meantime, experts recommend that people with back pain consult with healthcare providers to find individualized approaches that work best for their specific situation, recognizing that no single treatment works well for everyone.
Research Gaps and Future Directions
Both reviews identified significant gaps in the current research. The AAN study found insufficient evidence regarding the effectiveness of epidural steroid injections for neck pain. It also noted a lack of studies examining whether repeated treatments are effective or how treatments impact daily living and return to work.
Similarly, the broader review highlighted the need for more rigorous, placebo-controlled studies to better understand which treatments truly work for people with low back pain.
These findings underscore the importance of continued research to develop more effective interventions for a condition that remains challenging to treat despite its prevalence and impact on quality of life.
