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Not for the first time, a blow has been delivered to a commonly used intervention for low back pain (LBP). A high quality review1 demonstrated that paracetamol was no better than placebo for LBP, with any perceived clinical benefit probably reflecting natural history and/or placebo. This mirrors evidence that many other common interventions for LBP have limited effectiveness (eg, epidural injections, spinal manipulation and acupuncture). Furthermore, other interventions that carry significant risk (eg, nsaids, opioids and spinal surgery) do not demonstrate greater efficacy than low risk interventions such as exercise. Nevertheless, there are exponential increases in medication prescription, injections and surgical rates for LBP, with concurrent increases in disability levels.2 This suggests that practice is not changing in line with the evidence.
Emerging data on the mechanisms involved in LBP (1) explain why these approaches might be unsuccessful and (2) offer opportunities to enhance LBP management.
Why might these treatments be unsuccessful?
LBP is common and becomes persistent and disabling for a small proportion. While …
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.