Table 2
Frequency of interventions for acute low back pain in first week of treatment.
Intervention Recommendation (strength of evidence) % of study population a Nonsteroidal anti-inflammatory drugs Strongly recommended (A) 44.2% Ketorolac injection Strongly recommended (A) 15.8% Muscle relaxant Moderately recommended (B) 35.2% Capsaicin Moderately recommended (B) <0.1% Acetaminophen Recommended (C) 7.5% Tricyclic or serotonin norepinephrine reuptake inhibitor antidepressant Recommended (C) 0.1% Physical or occupational therapy b Recommended (I) 16.6% Manipulation Recommended (I) 11.2% Manual therapy/massage Recommended (I) 5.5% Lidocaine and topical creams No recommendation (I) 10.3% Infrared therapy No recommendation (I) 3.4% Ultrasound (therapeutic) No recommendation (I) 2.0% Electrical stimulation Not recommended (I) 15.1% Carisoprodol Not recommended (I) 2.9% Magnetic resonance imaging or computed tomography Not recommended (I) 1.8% Traction Not recommended (I) 1.3% Hot or cold therapy at appointment c Not recommended (I) 0.9% Acupuncture Not recommended (I) 0.2% Iontophoresis Not recommended (I) 0.2% Tender and trigger point injections Not recommended (I) 0.1% Electromyography Not recommended (I) 0.1% Functional capacity evaluation Not recommended (I) <0.1% Aquatic therapy (including swimming) d Not recommended (I) <0.1% Selective serotonin reuptake inhibitor antidepressant Not recommended (I) <0.1% Diagnostic facet joint injections (intraarticular and nerve blocks) Not recommended (I) <0.1% Bone scans Not recommended (I) <0.1% Intradiscal steroids Not recommended (I) <0.1% Fluoroscopy Not recommended (I) 0% Thermography Not recommended (I) 0% Videofluoroscopy Not recommended (I) 0% Ultrasound (diagnostic) Not recommended (I) 0% Adhesiolysis Not recommended (I) 0% Implantable spinal cord stimulators Not recommended (I) 0% Diathermy Not recommended (C) 0.7% Anticonvulsants Not recommended (C) 0.2% Epidural injections Not recommended (C) <0.1% X-ray Moderately not recommended (B) 49.6% Glucocorticoids Moderately not recommended (B) 3.2% Opioids Strongly not recommended (A) 19.6% Prolotherapy injections Strongly not recommended (A) 0.1% Discography Strongly not recommended (A) <0.1% a Data are not mutually exclusive.
b Specific types of exercise carry various A, B or C recommendation levels. For example, in the acute LBP setting, the favorable recommendations include progressive aerobic exercise (B) and directional stretching (C). This level of specificity was not available in the dataset.
c Heat and cryotherapies are recommended for home use.
d Aquatic therapy is recommended for select use in the subacute and chronic LBP patients for those with significant weight-bearing problems or other reasons to not engage in land-based exercise program.