This 2006 narrative review by Shen, Samartzis, and Andersson evaluates the evidence for a full spectrum of nonsurgical treatments — medications, exercise, manipulation, injections, orthoses, and alternative therapies — in both acute (<12 weeks) and chronic (>12 weeks) low back pain, to guide evidence-based nonoperative management.
When evaluating a patient with low back pain, anchor your treatment approach to duration: for acute pain, start NSAIDs ± muscle relaxants and keep the patient active; for chronic pain, prioritize structured exercise and consider caudal or transforaminal epidural steroids if radicular symptoms are present — and counsel all patients that the natural history is favorable regardless of intervention.
This 2006 narrative review by Shen, Samartzis, and Andersson evaluates the evidence for a full spectrum of nonsurgical treatments — medications, exercise, manipulation, injections, orthoses, and alternative therapies — in both acute (<12 weeks) and chronic (>12 weeks) low back pain, to guide evidence-based nonoperative management.
When evaluating a patient with low back pain, anchor your treatment approach to duration: for acute pain, start NSAIDs ± muscle relaxants and keep the patient active; for chronic pain, prioritize structured exercise and consider caudal or transforaminal epidural steroids if radicular symptoms are present — and counsel all patients that the natural history is favorable regardless of intervention.