Mayer JM, Haldeman S, Tricco AC, Dagenais S.
College of Medicine and School
of Physical Therapy and Rehabilitation Sciences,
University of South Florida, Tampa, FL 33612, USA.
Chronic low back pain (LBP) is a common and potentially disabling condition in all adults, including those who are physically active. It currently is challenging for clinicians and patients to choose among the numerous treatment options. This review summarizes recommendations from recent clinical practice guidelines and systematic reviews about common primary care and secondary care approaches to the management of chronic LBP. The best available evidence currently suggests that in the absence of serious spinal pathology, nonspinal causes, or progressive or severe neurologic deficits, the management of chronic LBP should focus on patient education, self-care, common analgesics, and back exercises. Short-term pain relief may be obtained from spinal manipulative therapy or acupuncture. For patients with psychological comorbidities, adjunctive analgesics, behavioral therapy, or multidisciplinary rehabilitation also may be appropriate. Given the importance of active participation in recovery, patient preference should be sought to help select from among the recommended treatment options.