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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
74%
41%
Supported by Evidence Treatment

Studies show that even patients with severe sciatica often respond well within six to 12 weeks to conservative treatment, which may include self-care (over-the-counter medications, heat and ice, stretching and exercises), physical therapy and/or prescription medication. Acetaminophen (e.g., Tylenol) and NSAIDs (e.g., ibuprofen (Advil, etc.) or naproxen (Aleve, etc.)) have been shown to effectively treat acute low back pain and mild to moderate chronic back pain without a specific cause, but there is little evidence specifically about these medications when pain is accompanied by sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
50%
32%
Supported by Evidence Treatment

Studies show that even patients with severe sciatica often respond well within six to 12 weeks to conservative treatment, which may include self-care (over-the-counter medications, heat and ice, stretching and exercises), physical therapy and/or prescription medication. Acetaminophen (e.g., Tylenol) and NSAIDs (e.g., ibuprofen (Advil, etc.) or naproxen (Aleve, etc.)) have been shown to effectively treat acute low back pain and mild to moderate chronic back pain without a specific cause, but there is little evidence specifically about these medications when pain is accompanied by sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
56%
31%
Inconclusive/Insufficient Evidence Evidence

Although the limited evidence available is based on poor-quality studies, topical capsaicin cream may offer some modest pain relief during an acute episode of back pain. However, there is no evidence specifically about topical treatments for sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
Ice
56%
29%
Inconclusive/Insufficient Evidence Evidence

There is still not enough evidence available to determine if icing is an effective for low back pain with or without sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
76%
32%
Inconclusive/Insufficient Evidence Evidence

Applying heat may help reduce acute low back pain and improve function when someone has had pain for less than three months. Benefit is small and short-lasting. Available evidence is limited and not specific to heat for treating sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
85%
47%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
32%
35%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
71%
48%
Supported by Evidence Treatment

Bed rest is shown to provides no benefit for back pain, and experts suggest that patients with acute low back pain and sciatica stay active.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
61%
42%
Supported by Evidence Treatment

There is evidence that exercise therapy - which may include strengthening and stretching exercises - helps reduce pain and improve function in adults with low back pain. However, although exercises may be an important part of your treatment plan, there is limited evidence specifically about exercises for sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
37%
22%
Supported by Evidence Treatment

There is fair evidence that chiropractic treatment (spinal manipulation) may be beneficial for sciatica when used in addition to other 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
24%
60%
Inconclusive/Insufficient Evidence Evidence

Although massage appears beneficial for relieving chronic low back pain, there is insufficient evidence about massage for acute low back pain or sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
10%
83%
Inconclusive/Insufficient Evidence Evidence

There is currently not enough evidence to support the use of acupuncture to provide relief 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
16%
60%
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. Outcomes for people who had surgery and those who were treated with conservative measures after one year were 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. Surgery for severe spinal stenosis, which can cause sciatica, appears beneficial, although 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
34%
52%
Inconclusive/Insufficient Evidence Evidence

Opioids and tramadol are effective treatments for moderate to severe symptoms associated with chronic low back pain; however, there is no evidence to suggest that it's as effective in treating acute or chronic low back pain with sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
34%
62%
Inconclusive/Insufficient Evidence Evidence

Opioids and tramadol are effective treatments for moderate to severe symptoms associated with chronic low back pain; however, there is no evidence to suggest that it's as effective in treating acute or chronic low back pain with sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
32%
50%
Inconclusive/Insufficient Evidence Evidence

Opioids and tramadol are effective treatments for moderate to severe symptoms associated with chronic low back pain; however, there is no evidence to suggest that it's as effective in treating acute or chronic low back pain with sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
31%
47%
Inconclusive/Insufficient Evidence Evidence

Opioids and tramadol are effective treatments for moderate to severe symptoms associated with chronic low back pain; however, there is no evidence to suggest that it's as effective in treating acute or chronic low back pain with sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
48%
47%
Supported by Evidence Treatment

Muscle relaxants and benzodiazepines (an antidepressant with muscle relaxant qualities) may help provide short-term relief of acute low back pain by relaxing the muscles; however, they can cause adverse side effects and generally are not recommended for long-term use.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
16%
30%
Supported by Evidence Treatment

Although tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) are not found to be effective for chronic back pain that doesn't have a known cause, both these antidepressants have been found to be effective at treating nerve pain associated with chronic back pain. There is currently no evidence to support using SSRIs or tricyclics to treat acute low back pain, however.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
44%
41%
Supported by Evidence Treatment

Studies show that even patients with severe sciatica often respond well within six to 12 weeks to conservative treatment, which may include prolonged physical therapy. If a herniated disk is responsible, physical therapy may be an integral part of 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
32%
65%
Inconclusive/Insufficient Evidence Evidence

Existing study results about steroid injections for nerve-related low back pain show conflicting evidence. Some trials showed benefit; others do not. Although injections may offer short-term pain relief, there may also be negative reactions, such as headache or short-term increased 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
11%
57%
Inconclusive/Insufficient Evidence Evidence

There is some evidence that back school relieves acute low back pain and improves function and back-to-work status in the short-term, but its effectiveness in the long-term is not certain. However, these studies do not specifically focus on back school as a treatment for sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
19%
58%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
6%
N/A
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
23%
50%
Supported by Evidence Treatment

There is fair evidence that chiropractic treatment (spinal manipulation) may be beneficial for sciatica when used in addition to other 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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
11%
14%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
10%
17%
Inconclusive/Insufficient Evidence Evidence

Cognitive behavioral therapy (talking therapy or mental health counseling) is shown to be moderately effective for people with chronic low back pain; however, there is no evidence specifically about this approach for treating sciatica.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
8%
60%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
47%
52%
Not Supported by Evidence Treatment

Bed rest is not recommended. Evidence shows that, at best, bed rest has no benefit. At worse, it can cause more pain and increase time to improve.

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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$
18%
45%
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

Ahn, Andrew C., "Acupuncture," UpToDate (Last Updated on March 5, 2013). www.uptodate.com. Accessed April 18, 2013.

Barry, Henry C., "Bed Rest Bad for Back Pain, Ineffective for Sciatica," Essential Evidence Plus Daily POEMs (May 31, 2005). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Barry, Henry C., "Tricyclics, Not SSRIs Effective for Chronic Back Pain," Essential Evidence Plus Daily POEMs (March 2004). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Nonsurgical Interventional Treatment," UpToDate (Last Updated on February 5, 2013). www.uptodate.com. Accessed April 18, 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 18, 2013.

Chou, Roger, "Subacute and Chronic Low Back Pain: Surgical Treatment," UpToDate (Last Updated on January 31, 2013). www.uptodate.com. Accessed April 18, 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....

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....

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C; Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):651-8. http://www.ncbi.nlm.nih.gov/pubm....

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....

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 18, 2013.

Krawciw, Donald, and Steven J. Atlas, "Occupational Low Back Pain: Treatment," UpToDate (Last Updated on March 7, 2013). www.uptodate.com. Accessed April 18, 2013.

Malmivaara, Antti, and Seppo Seitsalo, "Low Back Pain," Essential Evidence Plus EBM Guidelines (Last Updated on November 24, 2010). 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 18, 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....

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. http://onlinelibrary.wiley.com/d....

Shaughnessy, Allen F., "Epidural Steroids for Sciatica Minimally Effective in the Short Term," Essential Evidence Plus Daily POEMs (March 26, 2013). https://www.essentialevidenceplu.... Accessed April 18, 2013.

Shaughnessy, Allen F., "Massage Improves Function in Patients with Chronic Low Back Pain," Essential Evidence Plus Daily POEMs (September 2, 2011). 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.

Shekelle, Paul, "Spinal Manipulation in the Treatment of Musculoskeletal Pain," UpToDate (Last Updated on April 9, 2012). www.uptodate.com. Accessed April 18, 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 18, 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 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....

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. http://onlinelibrary.wiley.com/d....

$$$$$