Evidence-Informed Management of Chronic Low Back Pain (CLBP) Without Surgery

   The January-February 2008 issue of The Spine Journal is devoted to the evidence-informed management of chronic low back pain [subscription required]. See the editors’ preface at the bottom of this page.  Journal link    PubMed Records

Introduction:

• A supermarket approach to the evidence-informed management of chronic low back pain
• A systematic review of low back pain cost of illness studies in the United States and internationally

Link to the articles below from this page, until the DOIs are created. (As of April 3, 2008, the links below do not yet work.)

Intervention review articles:

• Evidence-informed management of chronic low back pain with adjunctive analgesics (21-27)
• … with back schools, brief education, and fear-avoidance training (28-29)
• … with cognitive behavioral therapy (40-44)
• … with epidural steroid injections (45-55)
• … with facet injections and radiofrequency neurotomy (56-64)
• … with functional restoration (65-69)
• … with herbal, vitamin, mineral, and homeopathic supplements (70-79)
• … with intradiscal electrothermal therapy (80-95)
• … with lumbar extensor strengthening exercises (96-113)
• … with lumbar stabilization exercises (114-120)
• … with massage (121-133)
• … with the McKenzie method (134-141)
• … with medicine-assisted manipulation (142-149)
• … with minimally invasive nuclear decompression (150-159)
• … with needle acupuncture (160-172)
• … with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics (173-184)
• … with opioid analgesics (185-194)
• … with physical activity, smoking cessation, and weight loss (195-202)
• … with prolotherapy (203-212)
• … with spinal manipulation and mobilization (213-225)
• … with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy (226-233)
• … with traction therapy (234-242)
• … with trigger point injections (243-252)
• … with watchful waiting (253-257)
• A brief overview of evidence-informed management of chronic low back pain with surgery (258-265)
• Editorial:
  What have we learned about the evidence-informed management of chronic low back pain (266-277)

Editors’ preface: The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing amongst available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient.

To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts.

Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.