Nonspecific lower-back pain: surgical versus nonsurgical treatment.
We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized controlled trials (ie, possibly those not previously included in the latest systematic reviews) were reviewed and added based on recommended procedures for the evaluation of methodological quality (ie, strong, moderate, and weak). In acute nonspecific lower-back pain (0-4 weeks duration of pain) there is moderate to strong evidence that self-care with over-the-counter medication and maintaining activity as tolerated or treatment with a limited number of sessions of manipulative therapy is effective for pain relief. In subacute nonspecific lower-back pain (4-12 weeks duration of pain) there is weak to moderate evidence that a graded activity program including exercises and cognitive behavioral treatment in combination is more efficient than usual care with regard to return to work. There is strong evidence that these programs reduce work absenteeism. In cases of chronic nonspecific lower-back pain (> 12 weeks duration of pain) a variety of treatments are available with limited and similar efficacy on pain and disability reduction. There is moderate evidence that surgery in chronic nonspecific lower-back pain is as effective as cognitive behavioral treatment with regard to pain, function, mood and return to work. Surgical indications for chronic nonspecific lower-back pain remain ill defined.


METHODS
Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.
Nordin
Margareta
M
Occupational and Industrial Orthopaedics Center, Department of Orthopaedics, NYU Hospital for Joint Diseases, New York University Medical Center, New York, NY 10014, USA. margareta.nordin@nyu.edu
Balagué
Federico
F
Cedraschi
Christine
C
D000700:Analgesics / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D003657:Decision Making; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D019637:Orthopedic Procedures / Q000379:methods*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index
D000700:Analgesics