Lancet Rheumatol
Non-surgical treatments show modest, sustained benefit for chronic low back pain
Study details: This systematic review and meta-analysis of 75 randomized trials (N = 15,395) evaluated the long-term (1–2 years) and very long-term (≥2 years) effectiveness of non-surgical interventions for adults with chronic low back pain. Interventions included cognitive behavioral therapy (CBT), mindfulness, exercise, goal setting, needling, and multidisciplinary care, with comparators such as placebo, usual care, or no intervention. Risk of bias was high in most studies.
Results: There is moderate certainty evidence that CBT and mindfulness probably reduce pain intensity (mean difference: −7.2 and −10.0, respectively) and disability (−5.7 and −9.3) at long-term follow-up. Goal setting and needling also probably reduce disability. At very long-term follow-up, low certainty evidence suggests multidisciplinary care may reduce pain (−10.1) and exercise may reduce disability (−10.2). However, effect sizes are small and heterogeneity is present.
Clinical impact: Non-surgical interventions, especially CBT, mindfulness, and exercise, could provide small but sustained improvements in pain and disability in patients with chronic low back pain. However, the magnitude of benefit is modest, and the strength of evidence remains limited.
Source:
Jenkins HJ, et al. (2025, September). Lancet Rheumatol. Long-term effectiveness of non-surgical interventions for chronic low back pain: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40449512/