What non-pharmacological interventions are effective for managing thoracic back pain in primary care?

Effective non-pharmacological interventions for managing thoracic back pain in primary care include tailored advice and information to support self-management, encouraging continuation of normal activities, and promoting physical activity and exercise programmes adapted to the individual's needs and capabilities. Group exercise programmes, which may include biomechanical, aerobic, mind–body, or combined approaches, are recommended within the NHS for specific episodes or flare-ups of back pain. Manual therapy such as spinal manipulation, mobilisation, or soft tissue techniques (e.g., massage) can be considered but only as part of a treatment package that includes exercise, with or without psychological therapy. Psychological therapies using a cognitive behavioural approach may also be considered as part of a combined treatment package for persistent pain, especially when psychosocial obstacles to recovery exist or previous treatments have been ineffective. Return-to-work or normal daily activity programmes should be promoted and facilitated. Interventions not recommended include belts, corsets, foot orthotics, rocker sole shoes, traction, acupuncture, and various electrotherapies such as ultrasound, TENS, PENS, and interferential therapy. For chronic primary pain, supervised group exercise and psychological therapies like acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) are advised, while biofeedback and electrical physical modalities are not recommended.