A new study suggests that only about 1 in 10 common non-surgical and non-invasive treatments for lower back pain are actually effective—and even then, the relief they provide is only slightly better than a placebo.
The study, published in BMJ Evidence-Based Medicine, analyzed results from 301 clinical trials across 44 countries.
Researchers reviewed treatments such as painkillers, exercise, massage, acupuncture, and spinal manipulation to see how well they worked compared to a placebo.
Back pain: A common but hard-to-treat problem
Lower back pain is one of the most common health issues worldwide.
It can be chronic (long-term) or acute (short-term), and in 80–90% of cases, doctors can’t find a clear cause. Because of this, treatment usually focuses on managing pain rather than curing the condition.
Doctors often recommend non-surgical and non-invasive treatments before considering surgery, but with so many options available, it’s hard to know which ones actually work.
The study grouped treatments into two categories:
- Pharmacological treatments – medications such as NSAIDs (like ibuprofen), opioids, muscle relaxants, and antidepressants.
- Non-pharmacological treatments – therapies like exercise, acupuncture, massage, spinal manipulation, and laser therapy.
After analyzing data from 56 different treatments, researchers found that:
- For acute back pain, only NSAIDs showed any real benefit.
- For chronic back pain, the only treatments with some effectiveness were exercise, spinal manipulation, taping, antidepressants, and TRPV1 agonists (drugs that target pain receptors).
However, even the most effective treatments provided only small improvements in pain relief compared to placebo.
Many popular treatments showed no benefit
The study found moderate-quality evidence that some commonly used treatments don’t work for acute back pain, including:
- Exercise
- Steroid injections
- Paracetamol (acetaminophen)
For chronic back pain, the following treatments showed no clear benefit:
- Lidocaine (a numbing medication)
- Antibiotics
Researchers also found inconclusive evidence for many other treatments, including:
- Acupuncture
- Massage therapy
- Osteopathy
- TENS (electrical nerve stimulation)
- Muscle relaxants
- Bisphosphonates (bone-strengthening drugs)
Why are the results uncertain?
One major issue is that many clinical trials on back pain treatments are small and inconsistent. Some studies used different types of placebo treatments, which could affect how well the results compare.
The researchers concluded that there is no strong evidence that any common non-surgical treatment provides major pain relief. While current guidelines suggest using these treatments, better research is needed to figure out which options actually work.
Until then, people with back pain may need to manage their expectations and work with their doctors to find the best treatment for their specific condition.
