Systematic review informs new guideline on acute low back pain care

A systematic review of 105 studies synthesized evidence on evaluation and management of acute low back pain (under 6 weeks duration) to support development of a multidisciplinary clinical guideline. The review reports that few clinical factors reliably rule in or out serious spine pathology, psychosocial factors best predicted progression to persistent pain, and early imaging did not improve outcomes in patients without red-flag signs. It found moderate-confidence benefit for NSAIDs, manipulation/mobilization, acupuncture, muscle relaxants, advice to stay active, and early physical therapy referral, while opioids showed no clear benefit over placebo and carried higher harm risk, and evidence on steroids for radiculopathy was low confidence.

Most relevant for: Clinicians evaluating and managing patients presenting with acute low back pain of less than six weeks duration, including those with radiculopathy.

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