Management for chronic nonspecific low back pain

Management of chronic nonspecific low back pain should follow the same principles as for other types of noninflammatory chronic pain and should be based on an integrated biopsychosocial approach. The components of management for persisting acute nonspecific low back pain also apply.

Exercise may provide small benefits for chronic nonspecific low back pain and maintaining physical activity should be encouraged. Multidisciplinary rehabilitation programs aim to simultaneously address the physical, psychological and social components of the patient’s pain experience. These programs may reduce pain and improve physical function; however, the ideal content and context for them, including the number and duration of sessions, is unclear.

Corticosteroid injections, including epidural and facet joint injections, are not recommended for nonspecific low back pain as current evidence indicates they are unlikely to provide substantive benefitMorrisroe, 2018.

Anaesthetic blocks or provocation techniques may be used to attempt to identify specific structures that may be responsible for low back pain. However, currently, there are no proven treatment options for patients with chronic low back pain in whom such investigations suggest a nociceptive input from discs or sacroiliac joints. There is limited evidence that percutaneous radiofrequency facet denervation provides pain relief in the small number of individuals demonstrated to have isolated facet joint pain. The proponents of these techniques assert that meticulous identification of appropriate patients is required and that these techniques should only be undertaken by skilled treatment providers in specialist centres. Decisions to investigate chronic nonspecific low back pain for therapeutic purposes should be coordinated by specialists; current evidence does not justify widespread use of this approach.

Evidence does not support a role for surgery in chronic nonspecific low back pain.