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European guidelines for the management of chronic, non-specific low back pain
Recommendations of Working Group B13 appointed by the Directorate-General for Research of the European Commission Department of Policy, Coordination and Strategy, /Eur Spine J (2006) 15 (Suppl. 2): S195 DOI 10.1007/s00586-006-1072-1
Summary of treatment concept:
Conservative treatment:
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Cognitive-behavioral therapy, supervised exercise therapy, concise educational approach, and multidisciplinary (bio-psycho-social) treatment - each of these methods can be applied.
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"Back schools" (for temporary improvement), short-term treatment through manipulations/mobilizations can also be considered.
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The use of physical therapy/physiotherapy (heat/cold therapy, traction, laser, ultrasound, shortwave diathermy, interferential currents, massage, braces) cannot be recommended.
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We do not recommend the use of TENS therapy / transcutaneous electrical nerve stimulation.
Pharmacological treatment:
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Short-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and weak opioids can be recommended for pain relief.
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Noradrenergic and specific serotonergic antidepressants, muscle relaxants, and capsaicin patches (cayenne pepper) may be considered for pain relief.
Invasive treatment:
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Acupuncture, epidural corticosteroid injections, facet joint steroid injections, local nerve blocks, trigger point injections, botulinum toxin, radiofrequency ablation of facet joints, radiofrequency ablation of dorsal root ganglion, intradiscal electrothermal therapy, and spinal cord stimulation are not recommended for the treatment of nonspecific lower back pain.
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Intradiscal injections and prolotherapy/regenerative disc therapy are not recommended.
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Percutaneous electrical nerve stimulation (PENS) and neuroreflexotherapy may be considered if available.
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Surgical intervention may be considered only after 2 years of ineffective conservative treatments, including multidisciplinary, comprehensive cognitive therapy programs and therapeutic exercise, if they can be applied. After meeting these conditions, surgical intervention may be proposed to carefully selected patients with a maximum of 2-level degenerative disc disease.
Additional comment from working group B13:
It is possible that many procedures described as "not recommended" in these guidelines (due to lack of evidence of effectiveness or conflicting evidence on their effectiveness) may actually prove to be effective when tested in a high-quality randomized controlled trial. Many of these treatment methods are widely used, so we encourage conducting carefully designed studies to determine whether further use of these methods is justified.
Recommendations from clinical practice guidelines focusing on the approach to patients with acute low back pain
Primary care health services
