Acute Lower Back Pain: Keep Things Simple

Most episodes of acute lower back pain will resolve spontaneously, and guideline-recommended treatment consists primarily of reassurance and acetaminophen. Many physicians (and patients), however, will turn as well to nonsteroidal anti-inflammatory drugs, physical therapy, or both. How helpful are these additional interventions?

Australian investigators enrolled 240 adults who complained of lower back pain for less than 6 weeks’ duration with or without sciatica. All patients received advice and acetaminophen; in addition, they were randomized to receive diclofenac, spinal manipulation, both, or neither, in a placebo-controlled factorial design. Spinal manipulation consisted of two or three weekly individualized sessions aimed at loosening the vertebral and pelvic joints; mock manipulation consisted of detuned pulsed ultrasound treatment. Neither diclofenac nor spinal manipulation hastened recovery (defined as 7 consecutive pain-free days); patients who received both additional interventions recovered no more quickly than those who received neither. Other than a single episode of diclofenac allergy, no significant adverse events were reported.