PM&R News   •   December 2017

Back pain continues to be one of the most common reasons for clinic visits and one of the most costly diagnoses. As physiatrists, we often prescribe physical therapy and attempt to motivate the patient that they can improve.  However, is physical therapy beneficial in improving outcomes in non-specific acute, subacute, or chronic low back pain or are we contributing to the rising cost of healthcare? This Cochrane review evaluated the effectiveness of physical therapy in non-specific low back pain. Sixty-one randomized controlled trials were included with many of them focusing on chronic low back pain. Improvement in pain and function were present in chronic back pain at all follow up periods. In subacute populations, graded activity exercises showed some evidence for effectiveness in follow up periods. Unfortunately, in acute low back pain, physical therapy was no more effective than no treatment or other conservative treatments, such as massage and activity modification.

In addition, NSAIDs are one of the most commonly prescribed medications for low back pain, but they tend to come with significant risk of side effects. Another Cochrane review evaluated if NSAIDs are more effective than other treatments in low back pain.  The authors found minimal effectiveness for short term symptomatic relief in patients with acute and chronic low back pain without sciatica. There is evidence that NSAIDs are not more effective than acetaminophen, which has a lower side effect profile.