Management of low-back pain in family practice: a critical review

There is a profusion of both orthodox and unorthodox treatments for low-back pain, many of which have been inadequately evaluated. Conflicting claims exist for nearly all of these treatments. To assess the evidence supporting these commonly used conservative therapies in family practice, a set of methodological criteria for evaluating the validity and usefulness of the results was applied to original articles which described trials of bed rest, exercises, manipulation, drug therapy, advice/education, and other therapies such as traction, corsets and transcutaneous nerve stimulation (TNS). Guidelines for managing acute back pain and acute back pain with sciatica are indicated. Key questions and certain physical signs which suggest a functional overlay in a patient with chronic back pain are also outlined.