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The Somatic Connection  |   May 2017
Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
Author Notes
  • Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   May 2017
Noninvasive Interventions Efficacious in Reducing Symptoms of Low Back Pain
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 335-336. doi:10.7556/jaoa.2017.064
The Journal of the American Osteopathic Association, May 2017, Vol. 117, 335-336. doi:10.7556/jaoa.2017.064
Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain. Rockville, MD: Agency for Healthcare Research and Quality; 2016. AHRQ Publication No. 16-EHC004- EF. 
Low back pain (LBP) is one of the most frequently encountered conditions in clinical practice, with up to 84% of adults reporting having had LBP at some time in their lives. The Agency for Healthcare Research and Quality (AHRQ) published a report aimed to assess the benefits of different pharmacologic and noninvasive, nonpharmacologic interventions for adults with acute, subacute, or chronic LBP. 
The AHRQ selected systematic reviews of randomized trials of pharmacologic interventions and nonpharmacologic interventions for patients with nonradicular or radicular LBP published before April 2015. Of the 2545 citations identified, 156 were included, most of which enrolled patients with pain symptoms of at least moderate intensity (defined as >5 on a 0- to 10-point scale). Excluded from the review were studies conducted among patients with LBP related to cancer, infection, inflammatory arthropathy, high-velocity trauma, fracture, or severe or progressive neurologic deficits. 
Evidence suggested that nonsteroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, opioids, exercise, and superficial heat were more effective than placebo or no intervention, but acetaminophen and systemic corticosteroids were no more effective than placebo in the management of acute LBP. For nonradicular chronic LBP, the review found that various pharmacologic and nonpharmacologic interventions were effective. Effective nonpharmacologic interventions included acupuncture, spinal manipulation, and multidisciplinary rehabilitation. Effective pharmacologic interventions included NSAIDs, opioids, tramadol, duloxetine, and benzodiazepines. Few trials evaluated the effectiveness of treatments for radicular LBP, but available evidence found that benzodiazepines, corticosteroids, traction, and spinal manipulation were not effective or were associated with nonsignificant effects. 
It should be noted that this report did not include the systematic review by Franke et al1 that formed the basis for the American Osteopathic Association's updated guidelines on osteopathic manipulative treatment (OMT) for patients with LBP.2 Franke et al's review showed that OMT has a significant effect on pain relief (mean difference, −12.91; 95% CI, −20.00 to −5.82) and functional status (standard mean difference, −0.36; 95% CI, −0.58 to −0.14) on patients with acute and chronic nonspecific LBP. The AHRQ should update their recommendations in light of this review and recommend OMT to manage symptoms in patients with LBP. 
References
Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. doi: 10.1186/1471-2474-15-286 [CrossRef] [PubMed]
Task Force on the Low Back Pain Clinical Practice Guidelines. American Osteopathic Association Guidelines for Osteopathic Manipulative Treatment (OMT) for Patients with Low Back Pain. J Am Osteopath Assoc. 2016;116(8):536-549. doi: 10.7556/jaoa.2016.107 [CrossRef] [PubMed]