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Table 4 Therapeutic interventions for persistent low-back pain (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  
Multidisciplinary program [39,73] Back school [65,74] Massage [57,67,74,75] Lumbar support [70,74,75]
- Efficacious if intensive, includes return to work component with visit of workplace. - Efficacy if short term and on workplace premises - Efficacy > no treatment  
   - Better efficacy if combined to exercises and education  
Behavioral therapy [41,74]   NSAIDs [51,52,74] Prolotherapy injection [76]
- Efficacy > no treatment or waiting list if includes cognitive approach and relaxation   - Efficacy to ↓ pain = acetaminophen for all NSAIDs  
Exercises [42,58,74]   Vertebral manipulations [55,56,75] Neuroreflexotherapy [78]
- No superiority of one type compared to another    
- Better if individualised    
   McKenzie approach [66]  
   Muscle relaxants [52,61]  
   - Evidence weaker than in acute phase  
   - Advantage over benzodiazepines  
   Antidepressants [52,61]  
   - Efficacy > placebo  
   - Advantage for tricyclic and tetracyclic  
   Acupuncture [62,63]  
   - Efficacy on pain and functional status  
   - Efficacy = other treatments  
   Steroid epidural infiltration [72,74]  
   Infiltration of trigger points [72,74]  
   Radiofrequency denervation [71,79]  
Cannot be recommended  
Bed rest [58,64,68,74] Injection therapy [72,74] Therapeutic ultrasounds [68,75]  
Mechanical tractions [58,74,75] TENS [58,75,77]   
  1. NSAID: non-steroidal anti-inflammatory drugs
  2. TENS: trans-cutaneous electrical nerve stimulation