Poster Presentation Sydney Spinal Symposium 2025

Long-term effectiveness of non-surgical interventions for chronic low back pain: a systematic review and meta-analysis (#34)

Hazel Jenkins 1 , Leticia Correa 1 , Benjamin Brown 1 , Giovanni Ferreira 2 , Casper Nim 3 , Sasha Aspinall 4 , Deborah Wareham 1 , Junghyun Choi 5 , Christopher Maher 2 , Mark Hancock 1
  1. Macquarie University, NSW, Australia
  2. Institute of Musculoskeletal Health, University of Sydney, Sydney
  3. University of Southern Denmark, Odense
  4. Murdoch University, Perth
  5. Namseoul University, Cheonan

Background: Chronic low back pain (LBP) is a long-term recurrent condition. Interventions with sustained benefits are needed to substantially reduce the associated personal and societal burden. We aimed to assess the long-term effectiveness of non-surgical interventions for reducing pain intensity and disability in adults with chronic LBP.

Methods: We performed a systematic review and meta-analysis. MEDLINE, EMBASE, and CINAHL were searched from inception until May 2024 for randomised controlled trials assessing non-surgical interventions in adults with chronic LBP. Studies assessing pain intensity and/or disability outcomes at long-term (1-2 years) and very long-term (≥2 years) follow-up were included. Comparators included placebo, adjuvant intervention, no intervention, or usual care. Random effects meta-analysis was performed for studies with similar populations, interventions, and outcome measures. 

Findings: Seventy-five trials (n=15,395) were included. Risk of bias was rated high for most studies (51/75). In people with non-specific chronic LBP, there was moderate certainty evidence that cognitive behavioural therapy and mindfulness likely reduce pain intensity (mean difference [95% confidence interval]: -7.2 [-9.8, -4.6], I2:0.0; and -10.0 [-14.4, -5.6], I2:0.1 respectively) and disability (-5.7 [-7.7, -3.7], I2:0.0 and -9.3 [-14.4, -4.1], I2:11.1 respectively); and goal setting and needling likely reduce disability (-8.3 [-12.8, -3.9], I2:4.8; and -4.8 [-8.1, -1.5], I2:0.0 respectively) at long-term follow-up.  There was low certainty evidence that multidisciplinary care may reduce pain intensity (-10.1 [-16.6, -3.7], I2:0.0) and exercise may reduce disability (-10.2 [-17.5, -2.9], I2:33.5) at very long-term follow-up. 

Interpretation: Some interventions, including cognitive behavioural therapy, mindfulness, exercise, and multidisciplinary care may produce the long-term benefits required to reduce the global burden due to non-specific chronic LBP; however, the effects are mostly small, and the strength of evidence is relatively uncertain. Greater attention is needed on developing and testing interventions with long-term effects for chronic LBP.