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Table 2 Therapeutic interventions for acute low-back pain (0–4 weeks)

From: An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project

Grade of scientific evidence
Strong Moderate Poor Lack of evidence
Can be recommended  
NSAIDs [51-54] Vertebral manipulations Steroid epidural infiltration for radicular pain [53] Physical agents (ice, heat, diathermy, ultrasounds) [58,59]
- Efficacy to ↓ pain = acetaminophen for all NSAIDs - Efficacy > placebo [53] - Efficacy > placebo or bed rest  
  - Efficacy > mobilisation for short term pain reduction [55]   
  - Efficacy = conservative treatment [56,57]   
Muscle relaxants [53,60] Exercises for disc herniation [42] Analgesics [52–54] Antidepressants [52,53,61]
-Efficacy of non-benzodiazepines > benzodiazepines; both with potential harm - Efficacy of extension > flexion - Non-opioids as efficacious as NSAIDs for pain relief  
   - Opioids: weak evidence of superiority to non-opioids  
Combination relaxants + NSAIDs or analgesics [60]   Lumbar support [53] Facet infiltrations [53]
- Efficacy > placebo   - Weak efficacy compared to no treatment  
   - Efficacy unknown compared to conventional therapies  
   - No efficacy for prevention  
Advice to remain active [36,59]   Acupuncture [62,63] Steroid epidural infiltration for non-radicular pain [53]
- Efficacy > conventional medical treatment   Steroid drugs [53] Back schools [65]
   McKenzie approach [66] Massage [57,67]
Cannot be recommended  
Bed rest [53,64] Exercises in flexion [42] TENS [53,58,68]  
   - Weak efficacy compared to other treatments  
   - No efficacy in meta-analysis  
Strengthening exercises [42]    
Specific exercises [42]    
Mechanical tractions [58,68,69]    
Exercises in extension [42]    
  1. NSAID: non-steroidal anti-inflammatory drugs
  2. TENS: transcutaneous electrical nerve stimulation