Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews. Rizzo RR, Cashin AG, Wand BM, Ferraro MC, Sharma S, Lee H, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Cochrane Database Syst Rev. 2025 Mar 27;3(3):CD014691. doi: 10.1002/14651858.CD014691.pub2. PMID: 40139265; PMCID: PMC11945228.
Analgesic effects of non-surgical and non-interventional treatments for low back pain: a systematic review and meta-analysis of placebo-controlled randomised trials. Cashin AG, Furlong BM, Kamper SJ, et coll. BMJ Evidence-Based Medicine. Publié en ligne le 18 mars 2025. doi: 10.1136/bmjebm-2024-112974
INESS: Rapport - Algorithme de prise en charge de la lombalgie avec ou sans douleur radiculaire, mars 2025
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.
Tableau synthèse efficacité traitements phase aigue et sub-aigue
Tableau synthèse efficacité traitements phase chronique
Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey. Jermini-Gianinazzi I, Blum M, Trachsel M, Trippolini MA, Tochtermann N, Rimensberger C, Liechti FD, Wertli MM. BMJ Open. 2023 Aug 4;13(8):e071893. doi: 10.1136/bmjopen-2023-071893. PMID: 37541755; PMCID: PMC10407374.
Diagnostics and treatment of acute non-specific low back pain: do physicians follow the guidelines? Trachsel M, Trippolini MA, Jermini-Gianinazzi I, Tochtermann N, Rimensberger C, Hubacher VN, Blum MR, Wertli MM. Swiss Med Wkly. 2025 Jan 24;155:3697. doi: 10.57187/s.3697. PMID: 39951547.
The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis, Sarah B. Wallwork, Felicity A. Braithwaite, Mary O’Keeffe, Mervyn J. Travers, Simon J. Summers, Belinda Lange, Dana A. Hince, Leonardo O.P. Costa, Luciola da C. Menezes Costa, Belinda Chiera, G. Lorimer Moseley, CMAJ Jan 2024, 196 (2) E29-E46; DOI: 10.1503/cmaj.230542
Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain : systematic review and network meta-analysis. Wewege M.A. et coll. : BMJ2023;380:e072962. doi.org/10.1136/bmj-2022-072962
Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Chou R, Deyo R, Friedly J, Skelly A, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S. Ann Intern Med. 2017 Apr 4;166(7):480-492. doi: 10.7326/M16-2458. Epub 2017 Feb 14. PMID: 28192790.
PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care. Kolber MR, Ton J, Thomas B, Kirkwood J, Moe S, Dugré N, Chan K, Lindblad AJ, McCormack J, Garrison S, Allan GM, Korownyk CS, Craig R, Sept L, Rouble AN, Perry D. Can Fam Physician. 2021 Jan;67(1):e20-e30. doi: 10.46747/cfp.6701e20. PMID: 33483410; PMCID: PMC7822613
Prevention and treatment of low back pain: evidence, challenges, and promising directions. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Lancet. 2018 Jun 9;391(10137):2368-2383. doi: 10.1016/S0140-6736(18)30489-6. Epub 2018 Mar 21. PMID: 29573872.
Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials, Liu et al. BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-070730 (Published 19 April 2023)
Diagnosis and management of low-back pain in primary care, Adrian Traeger, Rachelle Buchbinder, Ian Harris and Chris Maher, CMAJ November 13, 2017 189 (45) E1386-E1395
“Aide décisionnelle simplifiée de PEER : options de traitement des maux de dos chroniques en soins primaires.” Kirkwood, Jessica et al. Canadian family physician Medecin de famille canadien vol. 67,1 (2021): e15-e19. doi:10.46747/cfp.6701e15
Acétaminophène
Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials, BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1225 (Published 31 March 2015)
Conclusions: Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines.
AINS
Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis, Annals of the Rheumatic Diseases 2017;76:1269-1278
Conclusions: NSAIDs are effective for spinal pain, but the magnitude of the difference in outcomes between the intervention and placebo groups is not clinically important. At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo. There is an urgent need to develop new drug therapies for this condition.
Antidépresseurs
Efficacy of Low-Dose Amitriptyline for Chronic Low Back Pain: A Randomized Clinical Trial, JAMA Internal Medicine 2018 October 1
Gabapentinoïdes
Anticonvulsants for the Treatment of Low Back Pain and Lumbar Radicular Pain. Gottlieb M, Koyfman A, Long B. Acad Emerg Med. 2020 Jan 24. doi: 10.1111/acem.13924. [Epub ahead of print] PMID: 31981277
A Clinical Overview of Off-label Use of Gabapentinoid Drugs, JAMA Intern Med. Published online March 25, 2019. doi:10.1001/jamainternmed.2019.0086
Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis, CMAJ 2018 July 3;190:E786-93. doi: 10.1503/cmaj.171333
InterpretatIon: There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.
Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.Shanthanna H, Gilron I, Rajarathinam M, AlAmri R, Kamath S, Thabane L, Devereaux PJ, Bhandari M. PLoS Med. 2017 Aug 15;14(8):e1002369. doi: 10.1371/journal.pmed.1002369. eCollection 2017 Aug. Review.
CONCLUSIONS AND RELEVANCE: Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit. Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for CLBP merits caution. There is need for large high-quality trials to more definitively inform this issue.
Trial of pregabalin for acute and chronic sciatica. N Engl J Med 2017;376(12):1111-1120.
Conclusions: Treatment with pregabalin did not significantly reduce the intensity of leg pain associated with sciatica and did not significantly improve other outcomes, as compared with placebo, over the course of 8 weeks. The incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.
Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials, PLoS Med. 2017 Aug; 14(8): e1002369.
Conclusions and relevance: Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit.
Imagerie
Imaging strategies for low-back pain: systematic review and meta-analysis,The Lancet, Volume 373, Issue 9662, 7–13 February 2009, Pages 463-472
Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians, Ann Intern Med. 2011; 154(3):181-189. doi: 10.7326/0003-4819-154-3-201102010-00008
Imaging for low back pain, Choosing Wisely
Infophysiopt: prevalence of degenerative lumbar spine imaging findings in asymptômatic individuals
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.
Tableau
Incidental findings on magnetic resonance imaging of the spine in the asymptomatic pediatric population: a systematic review. Ramadorai U, Hire J, DeVine JG, Brodt ED, Dettori JR. Evid Based Spine Care J. 2014 Oct;5(2):95-100. doi: 10.1055/s-0034-1386753. PMID: 25278883; PMCID: PMC4174226.
Manipulations vertébrales
Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain, Systematic Review and Meta-analysis, JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086
Conclusions: Among patients with acute low back pain, spinal manipulation therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.
Non-specific low back pain, www.thelancet.com Vol 389 February 18, 2017
Opioïdes
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Jones CMP, Day RO, Koes BW, Latimer J, Maher CG, McLachlan AJ, Billot L, Shan S, Lin CC; OPAL Investigators Coordinators. Lancet. 2023 Jun 27:S0140-6736(23)00404-X. doi: 10.1016/S0140-6736(23)00404-X. Epub ahead of print. PMID: 37392748.
Interpretation: Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions.
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain, A Systematic Review and Meta-analysis, JAMA Intern Med. 2016;176(7):958-968. doi:10.1001/jamainternmed.2016.1251
Conclusions: In people with chronic low back pain, opioid analgesics provide short and/or intermediate pain relief, though the effect is small and not clinically important even at higher doses. Many trial patients stopped taking the medicine because they did not tolerate or respond to the medicine. There is no evidence on opioid analgesics for acute low back pain or to guide prolonged use of these medicines in the treatment of people with chronic low back pain.
Relaxants musculaires
Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis, A.G. Cashin et al, BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1446 (Published 08 July 2021)
Conclusions: Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty.
A Randomized, Placebo-Controlled Trial of Ibuprofen Plus Metaxalone, Tizanidine, or Baclofen for Acute Low Back Pain. Friedman BW, Irizarry E, Solorzano C, Zias E, Pearlman S, Wollowitz A, Jones MP, Shah PD, Gallagher EJ. Ann Emerg Med. 2019 Apr 5. pii: S0196-0644(19)30139-8. doi: 10.1016/j.annemergmed.2019.02.017. [Epub ahead of print]
CONCLUSION: Adding baclofen, metaxalone, or tizanidine to ibuprofen does not appear to improve functioning or pain any more than placebo plus ibuprofen by 1 week after an ED visit for acute low back pain.
Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain, Annals of Emergency Medicine. Volume 70, Issue 2, August 2017, Pages 169-176.e1
Conclusion: Among ED patients with acute, nontraumatic, nonradicular low back pain, naproxen+diazepam did not improve functional outcomes or pain compared with naproxen+placebo 1 week and 3 months after ED discharge.
A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain, https://doi.org/10.1016/j.annemergmed.2017.09.031
Conclusion: Among ED patients with acute, nontraumatic, nonradicular low back pain, combining naproxen with either orphenadrine or methocarbamol did not improve functional outcomes compared with naproxen+placebo
Thérapies physiques et Exercices
Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Pocovi NC, Lin CC, French SD, Graham PL, van Dongen JM, Latimer J, Merom D, Tiedemann A, Maher CG, Clavisi O, Tong SYK, Hancock MJ. Lancet. 2024 Jun 19:S0140-6736(24)00755-4. doi: 10.1016/S0140-6736(24)00755-4. Epub ahead of print. PMID: 38908392.
Interpretation: An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
A Prospective Observational Study of Emergency Department–Initiated Physical Therapy for Acute Low Back Pain, Howard S Kim, MD MS, Jody D Ciolino, PhD, Nicola Lancki, MPH, Kyle J Strickland, PT DPT, Daniel Pinto, PT PhD, Christine Stankiewicz, PT DPT, D Mark Courtney, MD MSCI, Bruce L Lambert, PhD, Danielle M McCarthy, MD MS, Physical Therapy, , pzaa219, https://doi-org.acces.bibl.ulaval.ca/10.1093/ptj/pzaa219
Conclusion: In this single-center observational study, ED-initiated physical therapy for acute low back pain was associated with improvements in functioning and lower use of high-risk medications compared with usual care; the causality of these relationships remains to be explored.