Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain

Abstract

Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient’s preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time.

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

“…It is worth highlighting that small effect sizes were obtained in the group of subjects who received the usual physiotherapy treatment. However, as other studies have shown, the existence of CS predicts poor outcomes obtained with classic local treatments, such as electrotherapy, motor control exercises, and surgery [107,108]. Sometimes PE can increase symptoms because descending inhibitory systems are not working properly [83], and some authors even point out that exercise can induce hyperalgesia if psychosocial factors such as fear of pain, catastrophism, and erroneous beliefs are not previously addressed, and this was not done in the CG [109].…”

Comparison of Trunk Muscle Activities during Pressure Feedback Monitoring among Individuals With and Without Chronic Low Back Pain

“…Animal experiment and mathematical model of the spine indicated that sequential injuries and deep muscles weakness resulted in spinal instability [2], which is defined as a significant decrease in the capacity of the spinal stabilizing system to maintain the intervertebral neutral zone within physiological limits [3]. Clinical guidelines suggested that spinal stabilization exercises (SSEs) may be as effective as other physiotherapy treatments in reducing disability and pain [4,5]. The principle of SSEs is to train the cocontraction pattern of the deep local trunk muscles of the transversus abdominis (TA) and the multifidus muscles (MF).…”

Effects of a Risk-Stratified Treatment in Patients with Chronic Back Pain in Rehabilitation: Results of a Controlled Clinical Trial

“…As the name suggests, FR puts emphasis on restoring body functions instead of simply reducing the pain, which used to be the dominant focus for recovery with regard to CLBP before FR was introduced. Since its introduction, systematic reviews have presented evidence that applying multidisciplinary biopsychosocial rehabilitation (MBR), which follows the principles of FR leads to reduced pain, quicker return to work or improved functions when compared to usual care or nonmultidisciplinary rehabilitation approaches [3,[5][6][7]. However, these findings were not uniformly confirmed [8][9][10].…”