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Nonsurgical Management of Acute and Chronic Low Back Pain

Dr. Shen is Assistant Professor, Department of Orthopedics, University of Virginia School of Medicine, Charlottesville, VA. Mr. Samartzis is Graduate Student, Faculty of Arts and Sciences, Graduate Division, Harvard University, Cambridge, MA and at the Division of Health Sciences, University of Oxford, Oxford, England. Dr. Andersson is Professor and Chairman, Department of Orthopedic Surgery, Rush Medical College, Rush University Medical Center, Chicago, IL.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shen, Mr. Samartzis, and Dr. Andersson.

Reprint requests: Dr. Andersson, Department of Orthopedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, 1471 Jelke, Chicago, IL 60612.

A variety of nonsurgical treatment alternatives exists for acute and chronic low back pain. Patients should receive appropriate education about the favorable natural history of low back pain, basic body mechanics, and methods (eg, exercises, activity modification, behavioral modification) that can reduce symptoms. Nonprescription medication is efficacious for mild to moderate pain. Nonsteroidal anti-inflammatory drugs, alone or in combination with muscle relaxants, relieve pain and improve overall symptoms of acute low back pain. Exercise therapy has limited value for acute low back pain, but strong evidence supports exercise therapy in the management of chronic low back pain. Moderately strong evidence supports the use of manipulation in acute back pain. Evidence is weak for the use of epidural corticosteroid injections in patients with acute low back pain, strong for short-term relief of chronic low back pain, and limited for long-term relief of chronic low back pain. The use of facet injections in the management of acute low back pain is not supported by evidence, nor is the effectiveness of orthoses, traction, magnets, or acupuncture. Trigger point injections are not indicated for nonspecific acute or chronic low back pain, and sacroiliac joint injections are not indicated in the routine management of low back pain. Conflicting evidence exists regarding the use of transcutaneous electrical nerve stimulation.

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