Non-specific low back pain is one of the most common ailments sending people to physiotherapy or chiropractic care. Given the numerous different mechanical, physiological and neurological reasons for back pain, many times, imaging and tests are inconclusive as to the origin of the back pain. The unfortunate patient is then lumped into NSLBP and given a hit and miss approach to back pain. This is not ideal as the review shows.
Briefly, as side note, in my personal experience, 3 common reasons for undiagnosed low back pain are sacro-illiac dysfunction (generally in nutation/flexion), poor lumbar extension and neurohypomobility.
Now, Machado et al 2008 completed a systematic review of 76 RCTs with placebo on treatments for NSLBP.
Interestingly, the ONLY treatments that score high enough that seem to merit an attempt in cases of NSLBP are electro-acupuncture and infrared treatments. It should be noted that this based on a single trial each of 25 and 38 individuals respectively. It is also noteworthy to see that colchicine, NMDA antagonists, PTIT, radiotherapy and behavioral modification can actually do worse than place placebo! These treatments should inherently be discontinued. Any treatment that can do worse than placebo is harming the patient. 1 large study of 120 demonstrated that standard physiotherapy treatment would have no major effect. Similarly 3 studies on exercise with a total of 204 subjects reported poor results. Spinal manipulation therapy (SMT) over 6 studies with 247 subjects reported slightly better than regular physiotherapy but not by much. Massage (which is far more superficial than SMT) and muscle relaxants both seem to have greater effects than something as basic as traction!
If someone is diagnosed with NSLBP and they are not responding to standard treatments, medications or falling into an easily understood category with a protocol- exploring electro-acupuncture and infrared treatments may be worth considering. While not everyone will respond to this treatment, it at least has a level of evidence worthy of consideration. Remember this the next time you are in the clinic and stumped with a bizarre case of NSLBP.