Struggling with Lower Back Pain? A Study Reveals Why It Persists

Back pain affects millions of people across the globe—and many sufferers aren’t finding relief.

A new study published in BMJ Evidence-Based Medicine reviewed hundreds of previous papers investigating whether non-invasive treatment options such as spinal manipulative therapy and taping helped to ease non-specific back pain, which is by far the most common type.

They found that only one in 10 treatments were effective, providing only slightly higher benefits than a placebo.

Among Americans, back pain is one of the most common health complaints, with 39% of U.S. adults reporting some form of it. For the many who live with this form of pain, the study’s results may be disheartening.

But according to study author Aidan Cashin, PhD, BExPhys, deputy director of the Centre for Pain IMPACT at Neuroscience Research Australia, they’re also not all that surprising. His team’s findings are broadly consistent with previous studies, he told Health, highlighting a lack of reliable evidence for the efficacy of many standard treatments.

Still, the new research revealed a glimmer of hope that some treatments may work better than others to improve acute or chronic lower back pain.

Here’s a closer look at which treatments may or may not bring relief—and what you can do if you’re suffering.

For the study, Cashin and his team focused on non-specific back pain, which means its origin has not been identified.

To build on existing evidence, the team selected 301 research trials that included people with non-specific back pain in 44 countries. These trials provided data on 56 different non-invasive treatments or treatment combinations, such as non-steroidal anti-inflammatory drugs (NSAIDs), exercise, acupuncture, laser therapy, spinal manipulative therapy, taping, and antidepressants.

“Once we identified the relevant studies, we grouped them by treatment and by duration of low back pain experienced by the participants,” Cashin explained. “This allowed for us to ensure we compared like with like.”

Their conclusion: Only one in 10 of the treatments brought more relief than a placebo.

That said, one treatment was deemed most effective for acute low back pain. NSAID drugs, which include aspirin and ibuprofen, appeared to relieve this shorter-term ailment better than other options.

For chronic pain, on the other hand, five treatments—exercise, spinal manipulative therapy, taping, antidepressants, and TRPV1 agonists—were most effective.

Meanwhile, the research concluded that three treatments for acute low back pain (exercise, glucocorticoid injections, and acetaminophen) and two for chronic low back pain (antibiotics and anesthetics) were largely ineffective and “unlikely to be suitable” for pain management.

However, the study had a few limitations. In examining trials that compared “real” treatments to “sham” or placebo treatments, it was difficult to maintain consistency with what counted as a sham. In some cases, the research also grouped similar treatment types together (like two different types of pain medication), potentially muddying results.

According to Cashin, the reasons why so many treatments don’t yield results are largely unknown.

“Low back pain is a common and complex problem which can be difficult to treat due to many possible contributors that could be causing and maintaining an individual’s back pain experience,” he said.

The “non-specific” in “non-specific back pain” may be part of the problem. Erica Urquhart, MD, PhD, a board-certified orthopedic surgeon specializing in sports medicine, joint health, and injury prevention, told Health that getting to the root cause of back pain is often necessary to guide effective treatment.

“As an orthopedic surgeon, it would be rare to leave a patient with a definitive, non-specific diagnosis of low back pain,” she said. Imaging and other testing can often pinpoint a specific cause of people’s pain, she explained, such as herniated disc syndrome, lumbar stenosis, or facet joint arthritis. From there, a healthcare provider can recommend the most helpful targeted treatments.

However, another theory is gaining traction in the medical literature. According to David D. Clarke, MD, president of the Association for the Treatment of Neuroplastic Symptoms, back pain treatments often fail because the “true source” of pain is the brain.

He pointed to a 2021 study in JAMA Psychiatry that found that 66% of patients with non-specific chronic back pain who received pain reprocessing therapy, a form of psychological treatment, were nearly pain-free at a one-year follow-up.

Further research may shed more light on whether a psychological, rather than physical, approach is most effective for non-specific back pain.

If so many treatments are unhelpful, what are you to do if you’re in the throes of a painful spasm or dealing with the longer burden of a chronic backache?

The study’s results confirm what many practitioners already advise.

Clarke said NSAID medications are a first line of defense, along with rest and physical therapy. For pain that persists for two or three months and beyond, he recommended an assessment for a structural cause. Urquart agreed. “In orthopedics, we have to define the clinical issue in order to provide an effective treatment plan,” she said.

In the absence of a physical cause, a psychological or stress-related one could be the next place to look, Clarke said. “Pain from this cause is just as severe and debilitating as that from structural causes and is most definitely not imagined,' he said.