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

Table 3 Therapeutic interventions for subacute low-back pain (4–12 weeks)

Grade of scientific evidence
Strong	Moderate	Poor	Lack of evidence
Can be recommended
Advice to remain active [36,53,64]	McKenzie approach [66]	Acupuncture [62]	Lumbar support [59,70]
- Graded activity + behavioral intervention = ↓ absence from work and ↓ risk of chronicity
Exercises [42,68]	Multidisciplinary program [39,59]	Vertebral manipulations [56,57]	TENS [68]
- no superiority of one type compared to another	- efficacious if intensive, includes return to work component with visit of workplace.	- Efficacy > placebo [53]
		- Efficacy > mobilisation to reduce short term pain [55]
		- As efficacious as other conservative treatments
		Massage [67]	Radiofrequency denervation [71]
		- Efficacy > no treatment
		- Better efficacy if combined to exercises and education
		Behavioral therapy [59]	Physical agents (ice, heat, diathermy, ultrasounds) [53]
		- Efficacy on pain and functional limitations > traditional care
		NSAIDs [51]	Steroid epidural infiltration [53]
		- Efficacy to ↓ pain = acetaminophen for all NSAIDs
		Analgesics [52–54]	Infiltration of trigger points [53,72]
		- Non-opioids as efficacious as NSAIDs for pain relief
		- Opioids: weak evidence of superiority to non-opioids
Cannot be recommended
		Bed rest [64]
		Mechanical tractions [68,69]

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