Non-pharmacological treatment of low back pain in primary care

Key points of this invited review article:

• Low back pain (LBP) is the leading cause of disability worldwide and is associated with a significant personal, social and economic burden.
• The use of often harmful and ineffective treatments (eg, opioids and surgery) represents a major challenge to the safe and appropriate management of non-specific LBP. 
• Greater emphasis is now placed on non-pharmacological treatments.
• Self-care advice and reassurance should form the mainstay of non-pharmacological treatment for non-specific LBP, but there is a lack of guidance on how best to deliver reassurance in a way that is acceptable to people with LBP.
• LBP is an unsolved problem and we currently lack truly effective treatments. Effects are often small and short lived and many treatments do not work at all.
• Honesty about the current lack of a genuine cure for LBP may encourage a greater self-care approach to LBP, and clinicians should be careful not to overexaggerate the benefits of any one treatment.