Both the Acute Back Pain Guideline and the Chronic Back Pain Guideline recommend spinal manipulation as an effective conservative treatment.

Interestingly, a lot of what’s considered “standard medical treatment” is listed as Invasive treatments, that should NOT be recommended for non-specific CLBP.

Those treatments include:

• Acupuncture,
  
• Bed rest
  
• epidural corticosteroids
  
• intradiscal injections
  
• intra-articular (facet) steroid injections
  
• local facet nerve blocks
  
• trigger point injections
  
• prolotherapy
  
• botulinum toxin
  
• radiofrequency facet denervation
  
• intradiscal radiofrequency lesioning
  
• intradiscal electrothermal therapy
  
• radiofrequency lesioning of the dorsal root ganglion
  
• and spinal cord stimulation

Percutaneous electrical nerve stimulation (PENS) and neuroreflexotherapy may be considered where available.

Their Conclusion: Surgery for non-specific CLBP cannot be recommended unless 2 years of all other recommended conservative treatments — including multidisciplinary approaches with combined programs of cognitive intervention and exercises — have failed, or such combined programs are not available, and only then in carefully selected patients with maximum 2-level degenerative disc disease.

Explore the complete Back Pain Europe website.