Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline
R. Chou, L. Huffman • 10/2/2007
Abstract
Many nonpharmacologic therapies are available for treatment of low back pain. In 1 study of primary care clinicians, 65% reported recommending massage therapy; 55% recommended therapeutic ultrasonography; and 22% recommended, prescribed, or performed spinal manipulation (1). In another study, 38% of patients with spine disorders were referred to a physical therapist for exercise therapy, physical therapies, or other interventions (2). Other noninvasive interventions are also available, including psychological therapies, back schools, yoga, and interdisciplinary therapy. Clinicians managing low back pain vary substantially in the noninvasive therapies they recommend (3). Although earlier reviews found little evidence demonstrating efficacy of most noninvasive therapies for low back pain (46), many more randomized trials are now available. This article summarizes current evidence on noninvasive therapies for low back pain in adults. It is part of a larger evidence review commissioned by the American Pain Society and the American College of Physicians to guide recommendations for management of low back pain (7). Pharmacologic therapies are reviewed in a separate article in this issue (8). Methods Data Sources and Searches An expert panel convened by the American Pain Society and American College of Physicians determined which nonpharmacologic therapies would be included in this review. Appendix Table 1 shows the 17 therapies chosen by the panel and how we defined and grouped them. Several therapies that have not been studied in the United States or are not widely available (such as acupressure, neuroreflexotherapy, spa therapy, and percutaneous electrical nerve stimulation) are reviewed in the complete evidence review (7). Therapies solely involving advice or back education are also reviewed separately, as are surgical and interventional pain procedures. Appendix Table 1. Included Interventions We searched MEDLINE (1966 through November 2006) and the Cochrane Database ...
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