Abstract
INTRODUCTION: Low back pain affects about 70% of people in resource-rich countries at some point in their lives. Acute low back pain can be self-limiting; however, 1 year after an initial episode, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. Acute low back pain has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may increase in severity and duration over time. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of non-drug treatments for acute low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). RESULTS: At this update, searching of electronic databases retrieved 1379 studies. After deduplication and removal of conference abstracts, 720 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 598 studies and the further review of 120 full publications. Of the 120 full articles evaluated, five systematic reviews and four RCTs were added at this update. We performed a GRADE evaluation for 46 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for nine interventions based on information relating to the effectiveness and safety of acupuncture, advice to stay active, back exercises, massage, multidisciplinary treatment programmes (for acute and subacute low back pain), spinal manipulation, temperature treatments (short-wave diathermy, ultrasound, ice, heat), and transcutaneous electrical nerve stimulation (TENS).