Low back pain (LBP) is among the most common musculoskeletal disorders globally, representing a leading cause of disability and healthcare expenditure. Its prevalence is expected to rise significantly in the coming decades, emphasizing the need for effective, evidence-based treatment strategies. This narrative review explores non-surgical approaches to LBP management, focusing on pharmacological and non-pharmacological therapies. It discusses the classification, pathophysiology, and red flag symptoms, alongside an evaluation of conservative treatments including NSAIDs, acetaminophen, muscle relaxants, opioids, antidepressants, physical therapy, acupuncture, spinal manipulation, and psychosocial interventions. The findings indicate that NSAIDs offer modest short-term relief and remain first-line pharmacological agents, while acetaminophen has limited efficacy. Muscle relaxants may benefit acute cases but carry notable side effects, particularly in older adults. Opioids, though effective in the short term, show minimal long-term benefit and a high risk of dependence. Non-pharmacological treatments—especially exercise therapy, manual therapy, and cognitive-behavioral interventions—demonstrate consistent efficacy in reducing pain and improving function. In conclusion, optimal management of LBP necessitates an individualized, multimodal approach that integrates pharmacological options with physical and psychological strategies to minimize harm, enhance function, and address biopsychosocial contributors to pain.
Ksiazek et al. (Sat,) studied this question.