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How to Read this Table

All data from this table comes from our national survey of people like you - peers - and medical professionals - doctors.

Click a column header (e.g., used by ) to sort the table.

Scale:
o
37%
O
87%

Results are on a 0-100% scale. The larger the circle, the more popular/ effective the option

Used By

The popularity of each option among survey respondents, measured by the percentage who used each option

Effectiveness

How many survey respondents found each option helpful

Out-of-pocket Cost

An average of how much survey respondents spent on each option they used while treating this issue.

Scale:
  • $$$$$
  • $$$$$
  • $$$$$
  • $$$$$
  • $$$$$
  • $$$$$
  • Legend:
  • Evidence rating for treatment

All Treatments

 
TREATMENT
(Click treatment for details)
USED BY EFFECTIVENESS
Patients’ Reports
Clinical Evidence
COST
73%
40%
Supported by Evidence Treatment

Acetaminophen (e.g., Tylenol) or NSAIDs are both effective and commonly used to treat acute or chronic low back pain. Prolonged conservative treatment (over-the-counter pain relievers and staying active) can be effective for people who want to avoid surgery.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
50%
38%
Supported by Evidence Treatment

Acetaminophen (e.g., Tylenol) or NSAIDs are both effective and commonly used to treat acute or chronic low back pain. Prolonged conservative treatment (over-the-counter pain relievers and staying active) can be effective for people who want to avoid surgery.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
53%
33%
Inconclusive/Insufficient Evidence

There is not enough evidence to summarize the effectiveness of this treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
Ice
49%
36%
Inconclusive/Insufficient Evidence Evidence

There is no evidence that ice is beneficial for acute low back pain.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
72%
40%
Supported by Evidence Treatment

Heat can ease pain and improve function, although existing evidence is limited.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
81%
51%
Inconclusive/Insufficient Evidence Evidence

Staying active is recommended when someone has acute or chronic back pain. Bed rest is generally not recommended by experts. However, avoiding motions that make your symptoms worse, such as lifting, bending or twisting, may be recommended until you recover.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
28%
38%
Inconclusive/Insufficient Evidence Evidence

There is conflicting evidence about lumbar supports or back belts for preventing or treating acute and chronic back pain. Existing studies, which are generally lower quality, look at prevention, symptom improvement and days out of work. There are several findings from these studies, including: There was little or no difference in terms of preventing low back pain or the number of sick days between people with low back pain who used back supports versus those who received no treatment or those who were educated on lifting techniques. One smaller study found that back supports plus back school helped reduce number of sick days but did not help prevent low back pain. Back support in addition to standard medical care cut down on the number of days a person had pain and improved function, but this combination did not reduce days out of work. Four studies showed that there is little or no difference in terms of reducing pain and getting better between people with acute or chronic back pain who used back support versus those who did nothing. There is conflicting evidence about whether back supports speed or slow down return to work.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
59%
49%
Inconclusive/Insufficient Evidence

There is not enough evidence to summarize the effectiveness of this treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
58%
48%
Inconclusive/Insufficient Evidence Evidence

Exercise therapy is as effective as other conservative treatments for reducing pain and improving function. The National Institute for Health and Clinical Excellence (NICE) recommends a structured exercise program as a treatment for acute low back pain. Back exercises also appear more effective than using lumbar support or back school to prevent lower back pain from recurring.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
29%
50%
Inconclusive/Insufficient Evidence Evidence

Spinal manipulation doesn't appear any more or less effective than other treatments for acute low back pain. People who have had symptoms for under two weeks and who do not have any symptoms below the knee are most likely to benefit from spinal manipulation. There is some evidence that combined chiropractic interventions have some benefit.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
32%
57%
Inconclusive/Insufficient Evidence Evidence

There is not enough evidence to show whether massage is an effective treatment for acute low back pain. There is weak evidence that massage for chronic low back pain is beneficial.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
10%
44%
Inconclusive/Insufficient Evidence Evidence

There is not enough evidence to show whether acupuncture is an effective treatment for acute low back pain. Acupuncture appears to relieve pain in the short term for people with chronic back pain, but it's about as effective as other alternative treatments.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
13%
53%
Inconclusive/Insufficient Evidence Evidence

Surgery effectiveness depends on the procedure and individual situation. For example, one study of people with severe sciatica found that 60% of people who were treated with conservative measures did not need surgery to improve. Of those who had surgery and those who were treated with conservative measures, the outcome after one year was similar. Diskectomy in people with low back pain who had sciatica and a herniated disk who did not improve after being treated with conservative measures reported an improvement one year after the surgery compared to people who had physical therapy alone, but not after four or 10 years after the procedure. Evidence is limited and conflicting regarding surgery for degenerative lumbar spondylosis. One study found that surgery for severe lumbar spinal stenosis appears beneficial, but the comparison between those who had surgery and those who did not was limited due to people not following to their assigned treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
28%
54%
Supported by Evidence Treatment

Opioids are sometimes prescribed as a short-term treatment for people with severe pain although there is little evidence about the effectiveness of strong pain killers for acute low back pain. There is some evidence that opioid pain killers effectively improve pain and function in people with chronic low back pain, but these drugs are associated with significant negative side effects.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
21%
60%
Supported by Evidence Treatment

Opioids are sometimes prescribed as a short-term treatment for people with severe pain although there is little evidence about the effectiveness of strong pain killers for acute low back pain. There is some evidence that opioid pain killers effectively improve pain and function in people with chronic low back pain, but these drugs are associated with significant negative side effects.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
23%
53%
Supported by Evidence Treatment

Opioids are sometimes prescribed as a short-term treatment for people with severe pain although there is little evidence about the effectiveness of strong pain killers for acute low back pain. There is some evidence that opioid pain killers effectively improve pain and function in people with chronic low back pain, but these drugs are associated with significant negative side effects.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
19%
55%
Supported by Evidence Treatment

Opioids are sometimes prescribed as a short-term treatment for people with severe pain although there is little evidence about the effectiveness of strong pain killers for acute low back pain. There is some evidence that opioid pain killers effectively improve pain and function in people with chronic low back pain, but these drugs are associated with significant negative side effects.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
44%
54%
Inconclusive/Insufficient Evidence Evidence

Existing studies on muscle relaxants for back pain are small and poorly designed. However, these drugs appear effective but tend to cause adverse effects. Experts recommend they be used with caution if at all.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
15%
39%
Inconclusive/Insufficient Evidence Evidence

Antidepressants (tricyclic and SSRIs) don't appear effective for people with chronic nonspecific low back pain, but they may help treat people who have nerve pain or depression, along with chronic lower back pain.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
37%
50%
Inconclusive/Insufficient Evidence Evidence

Physical therapy may be helpful in treating back pain, but it's no more effective than other treatments. Exercise for non-specific low back pain appears slightly effective at easing pain and improving function.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
22%
53%
Inconclusive/Insufficient Evidence Evidence

There is not enough evidence to support injections to treat acute or chronic low back pain. The National Institute for Health and Clinical Excellence (NICE) recommends against any injection into the back.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
8%
43%
Supported by Evidence Treatment

There is some evidence that back schools help ease pain, improve function and help people get back to work in the short- or mid-term, compared to other physical treatments or advice alone. However, there is evidence that back pain prevention classes in the workplace are not effective for preventing back pain or reducing absences or costs.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
13%
52%
Inconclusive/Insufficient Evidence

There is not enough evidence to summarize the effectiveness of this treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
4%
51%
Inconclusive/Insufficient Evidence

There is not enough evidence to summarize the effectiveness of this treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
16%
56%
Inconclusive/Insufficient Evidence Evidence

Spinal manipulation doesn't appear any more or less effective than other treatments for acute low back pain. People who have had symptoms for under two weeks and who do not have any symptoms below the knee are most likely to benefit from spinal manipulation.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
18%
44%
Inconclusive/Insufficient Evidence Evidence

There is no conclusive evidence about the effectiveness of TENS.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
7%
29%
Supported by Evidence Treatment

Cognitive behavioral therapy is moderately effective when used to treat chronic back pain.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
10%
39%
Inconclusive/Insufficient Evidence Evidence

Existing, high-quality trials that have examined traction for treating low back pain have found that there is no strong evidence that traction is any more beneficial than no treatment for acute, sub-acute and chronic low back pain with or without sciatica. There is conflicting evidence whether traction has benefit for people with low back pain and sciatica; there is some evidence that continuous or intermittent, light-force traction could add benefit.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
41%
54%
Not Supported by Evidence Treatment

Bed rest is not effective, and experts may recommend avoiding best rest for people with acute or chronic back pain. Instead, staying active is generally recommended.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Sowa, Gwendolyn, and Anthony Delitto, "Exercise-Based Therapy for Low Back Pain," UpToDate (Last Updated on January 3, 2013). www.uptodate.com. Accessed April 16, 2013.

Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. http://onlinelibrary.wiley.com/d....

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. http://onlinelibrary.wiley.com/d....

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database of Systematic Reviews 2003, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
14%
34%
Inconclusive/Insufficient Evidence

There is not enough evidence to summarize the effectiveness of this treatment.

Evidence-based medicine is based on findings from medical studies that look at factors such as safety, effectiveness, and short- or long-term outcomes of different treatments.

Sources for Clinical Evidence Ratings

Barry, Henry C., "TENS Ineffective in Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (March 11, 2010). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Chou, Roger, "Patient Information: Low Back Pain in Adults (Beyond the Basics)," UpToDate (Last Updated on February 14, 2012). Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Pharmacologic and Noninterventional Treatment," UpToDate (Last Updated on October 16, 2012). www.uptodate.com. Accessed April 16, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 16, 2013.

Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Br_nfort G, Bouter LM. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 2. http://onlinelibrary.wiley.com/d....

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. http://onlinelibrary.wiley.com/d....

Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D. Opioids for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 3. http://onlinelibrary.wiley.com/d....

Ebell, Mark H., "Surgery of Some Benefit for Lumbar Spinal Stenosis," Essential Evidence Plus Daily POEMs (April 8, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. http://onlinelibrary.wiley.com/d....

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. http://onlinelibrary.wiley.com/d....

Gibson JNA, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database of Systematic Reviews 2005, Issue 4. http://onlinelibrary.wiley.com/d....

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. http://onlinelibrary.wiley.com/d....

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. http://onlinelibrary.wiley.com/d....

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 4. http://onlinelibrary.wiley.com/d....

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. http://onlinelibrary.wiley.com/d....

Knight, Christopher L., Richard A. Deyo, Thomas O. Staiger and Joyce E. Wipf, "Treatment of Acute Low Back Pain," UpToDate (Last Updated on December 21, 2012). www.uptodate.com. Accessed April 16, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 16, 2013.

Markova, Tsveti, "Back Pain (Low, Acute)," Essential Evidence Plus (Last Updated on May 12, 2012). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Matthews, Michele L., Hugh Silk and Henry Barry, "Back Pain (Low, Chronic)," Essential Evidence Plus (Last Updated on March 19, 2013). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. http://onlinelibrary.wiley.com/d....

Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. http://onlinelibrary.wiley.com/d....

Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Lumbar Supports Decrease Symptoms But Not Work Absence," Essential Evidence Plus Daily POEMs (January 22, 2008). https://www.essentialevidenceplu.... Accessed April 16, 2013.

Shaughnessy, Allen F., "NICE Guidelines for Low Back Pain," Essential Evidence Plus Daily POEMs (August 21, 2009). https://www.essentialevidenceplu.... Accessed April 16, 2013.

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