What is the most effective treatment for chronic lower back pain?

For chronic lower back pain, a combined physical and psychological treatment approach is recommended, particularly if there are significant psychosocial barriers to recovery or if previous treatments have been ineffective ²,³. This can include referral or self-referral to a group exercise programme, physiotherapy for manual therapy, and cognitive behavioural therapy (CBT) ²,³. NICE guidelines advise against offering selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, gabapentinoids, or antiepileptics for managing low back pain ¹. Spinal injections are also not recommended for managing low back pain ¹.

Consider referral for assessment for radiofrequency denervation for people with chronic low back pain if non-surgical treatments have not worked, the main source of pain is thought to come from structures supplied by the medial branch nerve, and they have moderate to severe localised back pain (rated 5 or more on a visual analogue scale) at the time of referral ¹. Radiofrequency denervation should only be performed after a positive response to a diagnostic medial branch block ¹.

For pharmacological management, oral NSAIDs can be considered for low back pain, using the lowest effective dose for the shortest possible period, with appropriate clinical assessment and monitoring ¹. Weak opioids may be considered for acute low back pain only if an NSAID is contraindicated, not tolerated, or ineffective, but are not recommended for chronic low back pain ¹. Paracetamol alone is not recommended for low back pain ¹.