Chronic Lower Back Pain Management
Nonpharmacologic Therapies
- Exercise therapy has good evidence of moderate efficacy for chronic low back pain and should be a cornerstone of treatment 1, 2
- Spinal manipulation shows moderate effectiveness for pain relief and functional improvement 1, 3
- Massage therapy provides fair evidence of effectiveness for chronic low back pain 3, 4
- Acupuncture has fair evidence supporting its effectiveness for chronic pain 2, 4
- Yoga (particularly Viniyoga) shows moderate evidence of effectiveness 2, 6
- Cognitive-behavioral therapy demonstrates good evidence of moderate efficacy for chronic low back pain 1, 7
- Mindfulness-based stress reduction has moderate-quality evidence supporting its use 2, 6
- Interdisciplinary rehabilitation (combining physical, psychological, and educational interventions) shows good evidence of effectiveness, particularly when intensive (>100 hours) 1, 7
- Functional restoration with cognitive-behavioral components is more effective than usual care for reducing work disability 5, 7
Pharmacologic Therapies
- NSAIDs (like ibuprofen) should be the first medication choice when pharmacologic therapy is needed, with moderate evidence showing small to moderate pain improvement 8
- Duloxetine may be considered as a second-line option with evidence of small improvements in pain and function 8
- Opioids should be avoided for chronic low back pain due to limited evidence of long-term efficacy and significant risks 8