Editing Back pain (section)

====Conservative Care====
Back pain is generally first treated with nonpharmacological therapy, as it typically resolves without the use of medication. Superficial heat and massage, acupuncture and spinal manipulation therapy may be recommended.<ref name=":0">{{cite journal | vauthors = Stockwell S | title = New Clinical Guideline for Low Back Pain Says Try Nondrug Therapies First | language = en | journal = The American Journal of Nursing | volume = 117 | issue = 5 | page = 16 | date = May 2017 | pmid = 28448354 | doi = 10.1097/01.naj.0000516263.01592.38 |doi-access=free | s2cid = 40086812 }}</ref> There is poor evidence for the effectiveness of most interventional treatments (drugs and surgery) for back pain and hence non-interventional treatments should be prioritized in the vast majority of cases.<ref>{{cite journal |last1=Orchard |first1=John |title=The fight between medicine and scepticism needs to be resolved by evidence: Book reviews |journal=JSAMS Plus |date=2023 |volume=2 |pages=100042 |doi=10.1016/j.jsampl.2023.100042|doi-access=free }}</ref><ref>{{cite book |last1=Mannix |first1=Liam |title=Back up: why back pain treatments aren't working and the new science offering hope |date=2023 |publisher=NewSouth Publishing |location=Sydney, N.S.W |isbn=9781742238081}}</ref>
* [[Heat therapy]] is useful for back [[spasm]]s or other conditions. A review concluded that heat therapy can reduce symptoms of acute and subacute low-back pain.<ref name="pmid16641776">{{cite journal | vauthors = French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ | title = A Cochrane review of superficial heat or cold for low back pain | journal = Spine | volume = 31 | issue = 9 | pages = 998–1006 | date = April 2006 | pmid = 16641776 | doi = 10.1097/01.brs.0000214881.10814.64 | s2cid = 9349942 }}</ref>
* Regular activity and gentle stretching exercises is encouraged in uncomplicated back pain and is associated with better long-term outcomes.<ref name=":8">{{Cite book|title=Rosen's emergency medicine : concepts and clinical practice| vauthors = Walls RM, Hockberger RS, Gausche-Hill M |isbn=978-0323354790|edition=Ninth|publisher=Elsevier|location=Philadelphia, Pennsylvania|oclc=989157341 |date=2017}}</ref><ref>{{cite journal | vauthors = Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB | title = Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD007612 | date = June 2010 | pmid = 20556780 | doi = 10.1002/14651858.CD007612.pub2 |doi-access=free}}</ref> Physical therapy to strengthen the muscles in the abdomen and around the spine may also be recommended.<ref name=":2">{{Cite book|title=Wall and Melzack's textbook of pain|date=2013|publisher=Elsevier/Saunders| veditors = McMahon SB |isbn=978-0702040597|edition=6th|location=Philadelphia, Pennsylvania|oclc=841325533|page= }}{{page needed|date=February 2021}}</ref> These exercises are associated with better patient satisfaction, although they have not been shown to provide functional improvement.<ref name=":8" /> However, one review found that exercise is effective for chronic back pain but not for acute pain.<ref name="pmid16034851"/> Exercise should be performed under the supervision of a healthcare professional.<ref name="pmid16034851">{{cite journal | vauthors = Hayden JA, van Tulder MW, Malmivaara A, Koes BW | title = Exercise therapy for treatment of non-specific low back pain | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD000335 | date = July 2005 | volume = 2011 | pmid = 16034851 | doi = 10.1002/14651858.CD000335.pub2 | pmc = 10068907 |doi-access=free}}</ref> Supervised walking programs have been shown to be cost-effective at reducing back pain recurrences.<ref>{{cite journal |last1=Pocovi |first1=Natasha C |last2=Lin |first2=Chung-Wei Christine |last3=French |first3=Simon D |last4=Graham |first4=Petra L |last5=van Dongen |first5=Johanna M |last6=Latimer |first6=Jane |last7=Merom |first7=Dafna |last8=Tiedemann |first8=Anne |last9=Maher |first9=Christopher G |last10=Clavisi |first10=Ornella |last11=Tong |first11=Shuk Yin Kate |last12=Hancock |first12=Mark J |title=Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial |journal=The Lancet |date=June 2024 |volume=404 |issue=10448 |pages=134–144 |doi=10.1016/S0140-6736(24)00755-4|doi-access=free |pmid=38908392 }}</ref>
* [[Massage therapy]] may provide short-term pain relief, but not functional improvement, for those with acute lower back pain.<ref name="Furlan20152">{{cite journal | vauthors = Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M | title = Massage for low-back pain | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD001929 | date = September 2015 | volume = 2015 | pmid = 26329399 | doi = 10.1002/14651858.CD001929.pub3 | pmc = 8734598 |doi-access=free}}</ref> It may also offer short-term pain relief and functional improvement for those with long-term (chronic) and subacute lower pack pain, but this benefit does not appear to be sustained after six months of treatment.<ref name="Furlan20152" /> There do not appear to be any serious adverse effects associated with massage.<ref name="Furlan20152" />
* [[Acupuncture]] may provide some relief for back pain. However, further research with stronger evidence is needed.<ref>{{cite journal | vauthors = Yeganeh M, Baradaran HR, Qorbani M, Moradi Y, Dastgiri S | title = The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis | journal = Complementary Therapies in Clinical Practice | volume = 27 | pages = 11–18 | date = May 2017 | pmid = 28438274 | doi = 10.1016/j.ctcp.2016.11.012 | url = https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1744388116302006 }}</ref>
* [[Spinal manipulation]] appears to provide similar effects to other recommended treatments for chronic low back pain.<ref>{{cite journal | vauthors = Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW | title = Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials | journal = BMJ | volume = 364 | pages = l689 | date = March 2019 | pmid = 30867144 | pmc = 6396088 | doi = 10.1136/bmj.l689 }}</ref> There is no evidence it is more effective than other therapies or sham, or as an adjunct to other treatments, for acute low back pain<ref>{{cite journal | vauthors = Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW | title = Spinal manipulative therapy for acute low-back pain | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 9 | pages = CD008880 | date = September 2012 | pmid = 22972127 | pmc = 6885055 | doi = 10.1002/14651858.CD008880.pub2 | collaboration = Cochrane Back and Neck Group }}</ref>
* "Back school" is an intervention that consists of both education and physical exercises.<ref name=":7" /><ref name=":15">{{cite journal | vauthors = Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, Lin CC, Maher CG | display-authors = 6 | title = Back Schools for chronic non-specific low back pain | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD011674 | date = August 2017 | issue = 8 | pmid = 28770974 | pmc = 6483296 | doi = 10.1002/14651858.CD011674.pub2 }}</ref> There is no strong evidence supporting the use of back school for treating acute, subacute, or chronic non-specific back pain.<ref name=":7">{{cite journal | vauthors = Poquet N, Lin CW, Heymans MW, van Tulder MW, Esmail R, Koes BW, Maher CG | title = Back schools for acute and subacute non-specific low-back pain | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD008325 | date = April 2016 | issue = 4 | pmid = 27113258 | doi = 10.1002/14651858.CD008325.pub2 |doi-access=free| pmc = 11074243 }}</ref><ref name=":15" />
* [[Shoe insert|Insoles]] appear to be an ineffective treatment intervention.<ref>{{cite journal | vauthors = Sahar T, Cohen MJ, Ne'eman V, Kandel L, Odebiyi DO, Lev I, Brezis M, Lahad A | display-authors = 6 | title = Insoles for prevention and treatment of back pain | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005275 | date = October 2007 | pmid = 17943845 | doi = 10.1002/14651858.cd005275.pub2 |doi-access=free}}</ref>
* While [[Traction (orthopedics)|traction]] for back pain is often used in combination with other approaches, there appears to be little or no impact on pain intensity, functional status, global improvement or return to work.<ref>{{cite journal | vauthors = Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Brønfort G, Bouter LM, van der Heijden GJ | display-authors = 6 | title = Traction for low-back pain with or without sciatica | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD003010 | date = August 2013 | volume = 2013 | pmid = 23959683 | pmc = 6823219 | doi = 10.1002/14651858.cd003010.pub5 }}</ref>