Background Low back pain is a very common condition with significant healthcare and economic consequences. The acute form (<3 months duration) often progresses to the well-researched chronic state. Acute low back pain is less well understood but managing it more effectively may help address the growing burden of the chronic condition. Aim This systematic review aimed to assess the evidence for the efficacy of exercise and opioid therapies to manage pain and function in acute low back pain using validated patient-reported outcome measures. Method Literature searches were performed of the databases, Web of Science, Pubmed, and Scopus, and a significant risk of bias analysis was performed on the results. Results After screening 1110 papers, 22 randomised controlled trials were included for review. Eighteen studies assessing various exercise interventions showed some evidence that they can improve pain and functioning outcomes up to 6 weeks from pain onset. Four opioid trials found limited evidence to support their use in managing acute low back pain. Risk of bias was found to be high for most of the exercise-based studies. Two opioid studies had a low risk of bias and two had some concerns. Conclusion Trials for exercise interventions lacked the robustness to make reliable conclusions, although they indicated possible benefits of their use for improving pain and functional outcomes up to 6 weeks. Opioid interventions cannot be recommended for managing acute low back pain. More high-powered randomised controlled trials with lower risk of bias are required to make more meaningful conclusions.
Hamid Hashemi (Thu,) studied this question.