title: Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.
abstract: BACKGROUND
  A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available.
  
  
  OBJECTIVE
  To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain.
  
  
  METHODS
  Ovid MEDLINE (January 2008 through February 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists.
  
  
  METHODS
  Randomized trials of 9 nonpharmacologic options versus sham treatment, wait list, or usual care, or of 1 nonpharmacologic option versus another.
  
  
  METHODS
  One investigator abstracted data, and a second checked abstractions for accuracy; 2 investigators independently assessed study quality.
  
  
  RESULTS
  The number of trials evaluating nonpharmacologic therapies ranged from 2 (tai chi) to 121 (exercise). New evidence indicates that tai chi (strength of evidence [SOE], low) and mindfulness-based stress reduction (SOE, moderate) are effective for chronic low back pain and strengthens previous findings regarding the effectiveness of yoga (SOE, moderate). Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain (SOE, low to moderate). Limited evidence shows that acupuncture is modestly effective for acute low back pain (SOE, low). The magnitude of pain benefits was small to moderate and generally short term; effects on function generally were smaller than effects on pain.
  
  
  CONCLUSIONS
  Qualitatively synthesized new trials with prior meta-analyses, restricted to English-language studies; heterogeneity in treatment techniques; and inability to exclude placebo effects.
  
  
  CONCLUSIONS
  Several nonpharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind-body interventions.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735).
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Richard
authors.initials: R
authors.lastname: Deyo
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Janna
authors.initials: J
authors.lastname: Friedly
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Andrea
authors.initials: A
authors.lastname: Skelly
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Robin
authors.initials: R
authors.lastname: Hashimoto
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Melissa
authors.initials: M
authors.lastname: Weimer
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Rochelle
authors.initials: R
authors.lastname: Fu
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Tracy
authors.initials: T
authors.lastname: Dana
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Paul
authors.initials: P
authors.lastname: Kraegel
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Griffin
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Sara
authors.initials: S
authors.lastname: Grusing
authors.affiliation: From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
authors.forename: Erika D
authors.initials: ED
authors.lastname: Brodt
mesh_terms: D015670:Acupuncture Therapy; D059787:Acute Pain / Q000209:etiology / Q000628:therapy*; D059350:Chronic Pain / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D026441:Mind-Body Therapies; D026741:Physical Therapy Modalities; D011613:Psychotherapy; D011843:Radiculopathy / Q000150:complications