Low Back Pain Treatment - An Evidence Update 

If you’ve ever experienced low back pain, you know that there is no shortage of opinions on how it should be treated. Some people recommend immediately getting an X-ray or MRI to make sure there is nothing seriously wrong. Others suggest seeing a chiropractor, physical therapist, or massage therapist while others vehemently oppose seeing one of those healthcare providers. 

Which can leave you wondering who you should see to manage the low back pain and which treatments are most effective. This post will look at the evidence on the various treatments used to lower back pain. 

Low Back Pain Clinical Guidelines

Clinical practice guidelines are created by organizations to help healthcare providers give effective treatment. The American College of Physicians (US), National Institute for Health and Care Excellence (Europe), and Toward Optimized Practice (Canada) are three of the organizations who have published clinical practice guidelines for low back pain. 


"Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms." -The Lancet

While there is not complete consensus between all of the guidelines, the treatment approach recommendation is similar. A recent series published in the Lancet on low back pain summarized the treatment recommendation from the guidelines. 

Effective Low Back Pain Treatment

In general, the treatment recommendations progress from self-management strategies, to non-pharmacologic treatments, then to pharmacologic treatments. All of the guidelines also recommend against the use of routine imaging, except if a sinister pathology is suspected that would change the course of care (for example, a fracture, infection, or cancer). 

For both acute low back pain (less than 6 weeks) and persistent low back pain (greater than 12 weeks), it is recommended to provide education on low back pain and advise to remain active. 

"These guidelines endorse the use of exercise and a range of other non-pharmacological therapies, alone and in combination, such as massage, acupuncture, spinal manipulation, Tai Chi, and yoga." - The Lancet


Adjunct treatments for acute low back pain include: superficial heat, spinal manipulation, massage, and acupuncture. As for pharmaceutical treatments, non-steroidal anti-inflammatory drugs (NSAIDs) were the only recommendation as an adjunct treatment. 

In persistent low back pain, exercise and cognitive behavioral therapy were recommended as routine treatments. Cognitive behavioral therapy is a treatment used to address fear of movement and other behaviors involved with low back pain. Adjunct treatments for persistent low back pain include: spinal manipulation, massage, acupuncture, yoga, and mindfulness-based stress reduction. NSAIDs and selective norepinephrine re-uptake inhibitors were the only pharmaceutical treatments recommended for persistent low back pain. 

Simply put, the combination of spinal manipulation, massage, and acupuncture are effective adjunct treatments for low back pain. Education about low back pain and advice to remain active are essential components in treating both acute and persistent low back pain. With persistent low back pain, exercise and cognitive behavioral therapy should also be included in the treatment plan.