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. 2019 Jul 19;8(7):1063. doi: 10.3390/jcm8071063

Table 2.

Overview of recommendations in (clinical) guidelines for chronic low back pain management.

Guideline Recommendation for CLBP
Bekkering et al. Dutch Physiotherapy Guidelines for Low Back Pain (2003) [82] Recommended
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    Exercise therapy (not clear which exercises are best): Strong evidence that exercise therapy is equally effective compared to passive physiotherapy techniques. Strong evidence that exercise therapy is more effective than standard care by the general practitioner.

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    Behavioral treatment: may be useful. Strong evidence for a moderately positive effect on pain compared to no treatment, waitlist or placebo. Effectiveness compared to other treatments not clear.
Not recommended
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    Traction

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    Biofeedback

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    Massage

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    Transcutaneous electrical nerve stimulation

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    Ultrasound

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    Electrotherapy

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    Laser therapy

Wong et al. Clinical guidelines for the noninvasive management of low back pain (2016) [86] Recommended
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    Education: Advice and information promoting self-management, evidence-based information on expected course and effective self-care options, advice to stay active.

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    Exercises: No recommendations for or against any specific type of exercise, consider patient preferences.

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    Manual therapy, including spinal manipulation

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    Multimodal rehabilitation: including physical and psychological interventions (e.g., cognitive/behavioral approached and exercise).

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    Recommended by some guidelines: Massage, acupuncture, antidepressants.
Not recommended
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    Muscle relaxants

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    Gabapentin

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    Passive modalities, including transcutaneous electrical nerve stimulation, laser, interferential therapy and ultrasound.
Qaseem et al. Noninvasive treatments for acute, subacute and chronic low back pain (2017) [85] Recommended
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    Exercise: Moderate-quality evidence for small improvements in pain relief and function when compared to no exercise or usual care. No evidence on which exercise regimen is best.

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    Motor control exercise: Low-quality evidence for the effectiveness of motor control exercise (small improvements in pain and function) compared to minimal intervention, general exercise, and multimodal physical therapy. Low quality of evidence found no differences between motor control exercises plus exercise or exercise alone.

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    Tai Chi: Low-quality evidence showed that Tai Chi results in moderate pain reduction compared to waitlist or no intervention.

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    Yoga: Low-quality evidence showed that yoga results in a small pain reduction compared to exercise.

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    Psychological therapies: Low-quality evidence showed positive effects of progressive relaxation therapy, mindfulness relaxation, electromyography biofeedback training, operant therapy and cognitive behavioral therapy compared to waitlist. Low-quality evidence shows no difference between psychological therapies and exercise or physical therapy, and no difference between psychological therapies plus exercise and exercise alone.

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    Multidisciplinary rehabilitation: Moderate-quality evidence for effectiveness to improve pain and disability compared to usual care, no treatment, or physical therapy.
Not Clear
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    Pilates

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    Acupuncture: Low-to-moderate-quality evidence shows effectiveness of acupuncture but compared to no treatment or sham treatment. No improvement found in function.

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    Spinal manipulation

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    Low-level laser therapy

Not recommended
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    TENS

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    Ultrasound

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    Lumbar support

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    Taping

National Guideline Centre. NICE Guideline Low back pain and sciatica (2016) [40] Recommended
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    Self-management: Provide advice and information tailored to the patient’s needs and capacities, including information on the nature of the pain, and encouragement to continue normal activities.

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    Exercise: Consider group exercise programs, take into account the patient’s specific needs, preferences and capabilities when choosing the type of exercise.

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    Manual therapy (spinal manipulation, mobilization or soft tissue techniques): Can be used, but only as part of a treatment package including exercise, with or without psychological therapy.

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    Cognitive behavioral therapy: As part of a treatment package, including exercise, with or without manual therapy.

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    Multidisciplinary biopsychosocial rehabilitation: Consider a combined physical and psychological intervention incorporating cognitive behavioral techniques when significant psychosocial obstacles limit recovery, or when previous treatments have not been effective.

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    Return to work: Promote and facilitate.

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    Normal activities of daily living: Promote and facilitate.

Not recommended
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    Opioids

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    Postural exercise or education

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    Orthotics, belt, corsets or rocker sole shoes

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    Traction

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    Acupuncture

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    Ultrasound

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    Percutaneous electrical nerve stimulation

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    Transcutaneous electrical nerve stimulation

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    Interferential therapy