Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Abstract

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to highquality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal antiinflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited. Significance: Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.

Lumbar Disc Herniation

“…Relative indications for acute surgery are discussed in the next section. Nonoperative management should consist of a multimodal approach including anti-inflammatory medications, education, and physical therapy [48].…”

Spinal manipulation is beneficial for nonchronic low back pain

“…However, several recent reviews on low back pain have only found good evidence for NSAIDs for acute, subacute and nonradicular low back pain [7][8]. Thus, it appears that the standard medical therapy recommended in this review is incongruent with the literature and multi-disciplinary best practice guidelines.…”

An Informatics Approach to Interprofessional Management of Low Back Pain: A Feasibility Study using the Omaha System

“…For this study, the research team reviewed the literature and selected a well-constructed recent systematic review of LBP clinical practice guidelines4 , 16 supplemented by a comprehensive systematic review of non-invasive treatments for LBP 17. This high-quality evidence was identified to closely reflect optimal clinical practice.…”