Back pain is mostly immune to treatment (still)
A big new review of back pain treatments seems to be just about as discouraging as it could possibly be. But tilt your head like a curious doggo for a different view, and maybe it’s not as bad as it seems? Here’s some good news about the bad news:
Given the amount of garbage out there, getting some relief from 1 in 10 treatments doesn’t actually strike me as being all that bad. And the winners are: NSAIDs, exercise, spinal manipulation, taping, antidepressants, and TPRV1 antagonists (like capsaicin in spicy rubs).
There’s a lot of “garbage in, garbage out” here, and it mostly confirms that we have inadequate rather than negative evidence. They were only reviewing placebo-controlled trials, which is a high bar to clear, and most of what they found wasn’t enough for conclusions. (And yet consumers are spending billions of bucks on those not-clinically-proven treatments. 😬) But the silver lining is that there could be good treatments that simply haven’t been tested enough yet.
The bad news about the bad news
Unfortunately, if tilt your head the other way, the bad news looks even worse than it seemed at first. Quite a bit worse.
The lucky handful of treatments that are being touted as effective here are offering really minor relief, all very damned-with-faint-praise.
And some of those small benefits are likely illusory — evidence that registered as a thumbs up in this review, but likely won’t stand up to scrutiny/replication.
And the reems of “inconclusive” evidence here? Most of that is extremely unlikely to ever get conclusive.
The bottom line is clear: back pain is largely immune to treatment … still. The results of this review are very similar to the 2009 version from many of the same authors — they just had more data to work with this time.
