A Prospective Interventional Study Comparing a Multimodal Intervention Incorporating Behavior, Exercise, Nutrition, Medication, and Posture With Exercise and Medication in Patients With Chronic Nonspecific Low Back Pain

Background and objectivesChronic nonspecific low back pain (CNLBP) is a leading cause of disability, and its management remains a significant challenge.While non-pharmacological interventions like exercise are recommended, the optimal treatment strategy is unclear.This study compared the effectiveness of a comprehensive, five-modality holistic program (behavior therapy, exercise, nutrition optimization, drugs, and posture training) with a standard two-modality intervention (exercise and drugs) for patients with CNLBP. MethodsThis prospective interventional study included 123 patients with CNLBP.Participants were randomly allocated to either a two-modality intervention (Group 1; n = 60) or a five-modality holistic program (Group 2; n = 63).The primary outcome was the between-group difference in pain (Visual Analogue Scale, VAS) at the six-month follow-up.Secondary endpoints, including changes in anxiety scores and analysis by pain location, were treated as exploratory. ResultsAfter six months, both groups showed clinical improvement.However, the five-modality group (Group 2) demonstrated statistically significant and superior improvements in pain compared to the two-modality group (Group 1).The between-group difference in mean improvement for the VAS score (3.65 vs. 1.55) was statistically significant (p < 0.001).Subgroup analysis revealed that patients with higher baseline anxiety showed significantly greater improvement with the holistic approach. ConclusionsFindings from the current study support the adoption of a holistic, multidisciplinary strategy for the management of CNLBP.The integration of behavior therapy, nutrition optimization, and posture training alongside conventional exercise and medication provides a superior, long-term therapeutic approach.A comprehensive, five-modality treatment program is significantly more effective than a standard twomodality intervention for improving pain in patients with chronic nonspecific spinal pain.