What’s the best treatment for back pain?

Back pain is one of the most frequent reasons for people going to the doctor, yet there has been no scientific evidence to test the effectiveness of the usual treatment of advice and exercise for medium-term low back pain.

A new study by a team of six researchers including four from the University of Sydney, has found that a combination of physiotherapist-directed exercise and advice seems to improve pain and function in the short term for patients with sub-acute (neither new nor chronic – that is, present for more than six weeks, but less than three months) low back pain.

In the trial, reported in Annals of Internal Medicine, the journal of the American College of Physicians, 259 adults with sub-acute low back pain received 12 real or sham physiotherapist-directed exercise sessions and three real or sham advice sessions over six weeks. The researchers measured patients’ pain and function after six weeks, three months and 12 months’ follow-up.

Compared with sham exercise and sham advice, patients who received real exercise and real advice had the most benefit at six weeks. The patients who received both real treatments had the best results at six weeks and three months. However, by 12 months, most of the benefits were no longer present because those who had received sham treatments began to improve.

The bottom line for patients is that exercise and advice are the only therapies that have proven effective for sub-acute lower back pain in a scientifically rigorous trial, study co-author Associate Professor Christopher Maher, of the University of Sydney, said.