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Table 3 Therapeutic interventions for subacute low-back pain (4–12 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  
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]  
  1. NSAID: non-steroidal anti-inflammatory drugs
  2. TENS: transcutaneous electrical nerve stimulation