Effectiveness of interventions for the treatment of non-specific chronic low back pain in adults: An overview of systematic reviews.

BACKGROUND

Non-specific chronic low back pain (NSCLBP) is the most prevalent form of low back pain globally and a leading cause of disability, affecting quality of life, work productivity, and healthcare systems. Despite many therapies, treatment responses remain inconsistent, highlighting the need for comprehensive evaluations of these interventions.

OBJECTIVE

To evaluate and synthesize evidence from systematic reviews on the effectiveness and safety of interventions for managing NSCLBP in adults.

METHODS

An overview of systematic reviews was conducted through searches in Cochrane Library, PROSPERO, MEDLINE/PubMed, LILACS, Embase, Scopus, Web of Science, and PEDro, with no language restrictions. Reviews were included if they analyzed randomized controlled trials (RCTs) assessing interventions for NSCLBP in adults, reported at least one clinical outcome, and used GRADE to assess the certainty of evidence, which restricted inclusion to reviews published from 2011 onwards. Methodological quality was assessed using ROBIS and AMSTAR 2.

RESULTS

Fifty systematic reviews comprising 1096 RCTs and 124,087 participants were included. Core stabilization, aerobic exercise, Qigong, spinal manipulative therapy, and stretching suggested benefits for pain reduction, while integrated pain management programs combining physical, psychological, and educational components showed moderate-to-large improvements in disability. Reporting of adverse events, quality of life, and recurrence outcomes was limited, and most reviews presented high risk of bias with low certainty of evidence.

CONCLUSION

Pharmacological and non-pharmacological strategies have been studied for NSCLBP, but evidence certainty remains low. Clinicians should prioritize multimodal strategies supported by moderate-certainty evidence and adapt treatment to individual contexts. High-quality primary studies are needed for NSCLBP.