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Back Pain – What Works? Results of the Largest Meta-analysis.

Worldwide, low back pain causes nearly 24 billion days lived with disability each year. From the first decade of this century to the second, that sum of disability increased 17.5%.

What’s more, two out of three people with low back pain continue to experience low back pain for a year or more.2 What can we do to give people their lives back? Advice on different remedies seems to be endless. To help sort the problem, Silvia Gianola and colleagues published the largest meta-analysis to date in January.1

A meta-analysis is a type of study where researchers combine the results of several other studies to make one, higher-powered study capable of more conclusive observations. The current meta-analysis incorporates 46 trials covering 8,765 people with non-specific, low-back pain. The studies measure 15 different treatments including acupuncture, back school, cognitive behavioural therapy, heat wraps, education, opioids, non-steroidal anti-inflammatories (NSAIDs), steroids, muscle relaxants, etc. Many of these were effective, but which were the most effective? Which were the best use of the patient’s time?

The Top 2 Most Effective,
Non-pharmacological Back Pain Treatments
(from most to least effective)

1. Manual therapy

2. Exercise therapy

Manual therapy refers to a clinician mobilizing joints, kneading the muscles, and other hands-on physiotherapy treatments. Some treatments were less effective than placebo. The list above takes into consideration all the results over different time frames from one week to one year. When we look at the most effective way to reduce pain at one week specifically, exercise therapy wins. At one week, exercise therapy appeared to be more effective than opioids and over-the-counter pain meds (non-steroidal anti-inflammatories). At one week, education is less effective than placebo.  

The most effective ways to reduce pain and disability from back pain are the methods we use at Advanced Physiotherapy and Injury Prevention. If back pain is slowing you down, please call (02) 4954 5330.


  1. Gianola S, Bargeri S, Del Castillo G, Corbetta D, Turolla A, Andreano A, Moja L, Castellini G. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. British Journal of Sports Medicine. 2022 Jan 1;56(1):41-50.

Costa LD, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis

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