Conservative Treatment Of Nonspecific Low Back Pain: A Randomized Controlled Trial

Low back pain(LBP) is a major health problem in modern society, most of which is nonspecific low back pain(NLBP). The therapeutic interventions for treatment of low back pain are divided into two categories: operation and conservative treatments. The latter is used more often. Although many conservative treatments are available, the effectiveness associated with most of the interventions has not yet been demonstrated and no single treatment modality seems to be superior to others. One of the major challenges for researchers in the field of low back pain is to provide evidence of which is of most benefit for subgroups of patients with low back pain. The goal of the current study is to compare HANS and exercise therapy with drug therapy respectively in the treatment of nonspecific low back pain.Materials and MethodsThe study consists of two parts. In part one, subjects (n=100) were grouped according to the duration of low back pain. Subjects with acute low back pain (4 weeks or less) were randomly assigned to HANS (n=25), as the experimental, and NSAIDs and/or muscle relaxants (n=25), as the controls. Subjects with sub-acute and chronic low backpain (more than 4 weeks) were randomly assigned to HANS (n=25), as the experimentals, and NSAIDs (n=25), as the controls. The principal efficacy criterion was back pain, as assessed on a 100-mm visual analogue scale (VAS), and functional disability, as assessed by the Roland-Morris activity scores, before treatment, and immediately and at 2 weeks and 6 weeks after treatment. In part two, subjects (n=100) were also grouped according to the duration of low back pain. Subjects with acute low back pain (4 weeks or less) were randomly assigned to exercise therapy (n=25), as the experimentals, and NSAIDs and/or muscle relaxants (n=25), as the controls. Subjects with sub-acute and chronic low back pain (more than 4 weeks) were randomly assigned to exercise therapy (n=25), as the experimentals, and NSAIDs (n=25), as the controls. The principal efficacy criterion was also back pain, as assessed on a 100-mm visual analogue scale (VAS), and functional disability, as assessed by the Roland-Morris activity scores, before treatment, and immediately and at 2 weeks and 6 weeks after treatment.ResultsIn part one, there was a significant decrease in pain sensation and functional disability in each group after treatment. In subjects with acute low back pain, the efficacy in both groups was similar after treatment(P>0.05). In subjects with sub-acute and chronic low back pain, the efficacy in both groups was also similar after treatment(P > 0.05) except that the between-group difference(P<0.05)was found in Roland-Morris activity scores immediately and at 2 weeks after treatment, and in VAS at 6 weeks after treatment. In part two, there was also a significant decrease in pain sensation and functional disability in each group after treatment. In subjects with acute low back pain, the efficacy in the controls was better than one in the experimentals after treatment(P<0.05). In subjects with sub-acute and chronic low back pain, the efficacy in the experimentals was better than one in the controls after treatment(P<0.05).Conclusions1. HANS is efficacious in the treatment of nonspecific low back pain, similar to NASIDs and/or muscle relaxants in efficacy but smaller in side effects for treatment of acute low back pain, and superior to NSAIDs for management of chronic low back pain. .2. Although exercise therapy is efficacious in the treatment of acute nonspecific low back pain, its efficacy is worse than NASIDs and/or muscle relaxants', so, it is usually not chose for treating acute nonspecific low back pain. However, in the treatment of sub-acute and chronic nonspecific low back pain, exercise therapy has an advantage over NASIDs, superior to NASIDs in efficacy but smaller in side effects.