Low back pain is one of the most common medical complaints in the world. Globally, over 600 million people suffer from it. That means at any given moment, millions of people are searching for relief—visiting doctors, trying alternative therapies, or popping painkillers. This has created an enormous industry that includes some questionable interventions.
But what if most of these treatments don’t actually work?
Seriously, if you feel like nothing is helping your back pain… you’re probably right. A new systematic review (a study of studies) found that only 10% of lower back pain treatments offer significant relief. Researchers found that the vast majority of non-surgical and non-interventional treatments for low back pain are ineffective or have uncertain benefits. So what works?
Most Treatments Hardly Outperform Placebo
This study—the largest of its kind—put various treatments for acute (lasting less than 12 weeks) and chronic (lasting more than 12 weeks) low back pain to the test. The results were startling.
For acute back pain, just one treatment—NSAIDs (like ibuprofen or naproxen)—showed a small but meaningful benefit. Meanwhile, paracetamol (acetaminophen) and glucocorticoid injections, though frequently recommended, were found to have no significant benefit over placebo. Other treatments, like exercise therapy, were also ineffective for acute pain, despite their benefits for chronic pain.
For chronic back pain, only five treatments had moderate-certainty evidence of effectiveness:
- Exercise therapy;
- Spinal manipulative therapy (like chiropractic adjustments);
- Taping (like kinesiology tape);
- Antidepressants;
- TRPV1 agonists (such as topical capsaicin creams).
That’s it. Everything else either didn’t work or had too little evidence to say for sure. But here’s the thing: even the things that did work had modest benefits.
We Really Need Better Back Pain Treatments
Overall, the researchers looked at a total of 301 trials (377 comparisons) which provided data on 56 different treatments or treatment combinations. Out of these, just one treatment for acute pain and five for chronic pain worked. Already, that’s concerning, as 9/10 prescribed treatments do almost nothing. But no treatment delivered a major and lasting reduction in pain, and most provided only slight relief.
“Our review did not find reliable evidence of large effects for any of the included treatments, which is consistent with clinical guidelines and our previous review. While we would like to provide more certain recommendations for where to invest and disinvest in treatments, it is not possible at this time,” the study reads.
Researchers emphasize that the evidence for these treatments is weak and unreliable. Many of the studies had small sample sizes, meaning there weren’t enough participants to draw strong conclusions. Some results were inconsistent, with different studies showing conflicting outcomes. For example, glucocorticoid injections and paracetamol for acute back pain, and antibiotics for chronic pain, all had results that overlapped with no effect, suggesting they likely provide little to no benefit. This doesn’t mean they don’t work for some people, just that based on current research, they lack hard proof.
Overall, this study shows that we urgently need better research and more reliable solutions for back pain.
“Evidence is inconclusive for other treatments due to few participants, imprecision, or being of low or very low certainty. Further large, high-quality trials may help reduce the uncertainty in the evidence for these treatments,” the researchers write in the study.
So, What Should You Do for Back Pain?
Again, it’s not that these interventions don’t work necessarily, but the evidence is weak. Based on existing science, nothing is really, truly, guaranteed to make a difference. But based on existing evidence, here’s what seems to have the best chance of working.
For chronic pain, exercise is the best long-term solution. Exercise therapy was one of the few treatments with moderate-certainty evidence of effectiveness. Strength training, stretching, yoga, and aerobic activity can all help. Make sure you don’t make any movements that put unnecessary pressure on your lower back, however. Don’t wait for your back pain to “go away” before exercising. Movement is often the cure. Start slow and build up over time.
NSAIDs also help with acute pain, but they should be used sparingly. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are the only proven pharmacological treatment for short-term back pain. However, they should not be used long-term due to potential side effects (stomach issues, kidney damage, and cardiovascular risks).
Chiropractic adjustments or osteopathic spinal manipulation showed a small benefit for chronic low back pain. However, the effect was modest, and results varied. Capsaicin, a compound found in chili peppers, can desensitize pain receptors when applied as a cream. The study found moderate-certainty evidence that it helps some people with chronic low back pain.
Also, rather curiously, antidepressants were one of the few pharmaceutical treatments that worked for chronic pain. This suggests a strong mind-body connection in how we experience pain. So taking care of your mental health could also be important as a long-term treatment. This isn’t the first study to suggest a connection between back pain and mental health.
Ultimately, there’s no magic cure for low back pain; or we haven’t found it yet. Most non-surgical treatments don’t work—or barely outperform a placebo. But a few strategies do offer real, albeit modest, relief. If you’re struggling with back pain, your best bet is to stay active, manage expectations, and avoid falling for ineffective or overpriced treatments. Sometimes, the simplest solutions—moving more, staying strong, and managing stress—are the best we have.
The findings are published in the medical journal BMJ Evidence-Based Medicine.
