Umbrella Review of Primary Care Treatments for Adults With Chronic Low Back Pain

Objectives: The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP).

Methods: We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria.

Results: Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment.

Conclusions: Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.