The Elusive Cure for Back Pain

If you’ve ever struggled to recover from a bad back, you’re not alone. A recent study has found that only about 10% of common back pain treatments provide any noticeable relief, and even then, the benefits are minimal.

Researchers in Australia led the study, which was published in BMJ Evidence Based Medicine. They analyzed data from hundreds of clinical trials testing dozens of back pain remedies and found that only a few treatments seemed more effective than a placebo. These treatments, including exercise and non-steroidal anti-inflammatory drugs (NSAIDs), likely provide a small benefit on average.

The Prevalence of Back Pain

Back pain, particularly low back pain, is one of the most common and frustrating afflictions affecting humanity today. Almost everyone will experience low back pain at least once in their lifetime. Roughly 10% of the world’s population currently suffers from an aching back, while about 40% of adults in the U.S. have had back pain in the last three months.

Most episodes of back pain fade away over time, but around 10% of Americans are thought to have chronic or recurring back pain. Nearly all back pain cases are non-specific, meaning there’s no clearly identifiable disease or structural reason to explain it.

The Search for Effective Treatments

Anyone who’s dealt with repeated bouts of back pain is likely familiar with the long list of supposed cures—and with how often they don’t seem to work. The researchers aimed to conduct the most extensive review yet of non-invasive, non-surgical back pain treatments, using data from studies considered the gold standard of medical evidence: randomized, placebo-controlled clinical trials.

The researchers reviewed 301 trials that covered 56 different treatments or treatment combinations for acute or chronic non-specific lower back pain. Lead study author Aidan Cashin, an exercise physiologist and deputy director of the Center for Pain IMPACT at Neuroscience Research Australia, said, "We were motivated to conduct this review because non-surgical and non-invasive approaches are recommended as the initial treatment approach. But many such options are available, and it’s not always easy to know which ones are effective."

The Findings

The researchers found that only NSAIDs seemed effective over placebo for acute back pain, while five treatments appeared to work for chronic back pain: exercise, spinal manipulation, taping, antidepressants, and TRPV1 agonists. Other treatments, including cannabinoids, muscle relaxants, opioids, acupuncture, and dry cupping, failed to meet the threshold for success.

Unfortunately, even the top-performing remedies were mediocre. The researchers had only moderate certainty in the data supporting any of these treatments, and their overall effectiveness was judged to be modest at best. "The current evidence shows that one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, providing only small analgesic effects beyond placebo," the researchers wrote.

The Need for More Research

While some people may experience substantial relief from one of these therapies, the researchers are calling for more high-quality studies to fill in the missing gaps of data. Many treatments have only been tested in small trials, and some commonly touted remedies have never been tested in placebo-controlled trials.

The Future of Back Pain Treatment

There isn’t a sure-fire, highly effective cure for back pain widely available right now, including surgery. The researchers acknowledge that many treatments only target a single potential contributing factor, which may explain why they’re not effective. More work is needed to understand what causes and maintains low back pain to develop more targeted treatments.

However, there is an emerging wave of new treatments that have shown promise in addressing the multiple drivers of back and other kinds of chronic pain, such as pain reprocessing therapy and graded sensorimotor retraining. These breakthroughs may eventually provide large and sustained benefits for people with chronic back pain.

As someone who’s regularly dealt with low back pain for years, exercise and a stretching routine seem to help keep it in check most of the time. But like the millions of sufferers out there, there’s hope that these breakthroughs will eventually become potent options for this often annoying, sometimes aggravating condition.