Update on Non-surgical Treatments for Lumbar Pain

Low back pain (LBP) is a very prevalent clinical condition worldwide. Approximately 90% of the cases are of nonspecific LBP, due to the lack of anatomopathological changes as potential causes of pain. A more assertive therapeutic approach requires identifying red or yellow flags and diagnosing the pain pattern (nociceptive, neuropathic, nociplastic, or mixed pain). Acute LBP prognosis is favorable in most cases, and the therapeutic objective is to prevent chronicity. For chronic LBP, the goals include pain reduction and improvements in functionality and quality of life. In acute and chronic cases, the principle of multimodal analgesia guides the treatment, which combines pharmacological, non-pharmacological, and interventional methods. The most common medications for LBP are simple analgesics, such as paracetamol, muscle relaxants, nonsteroidal antiinflammatory drugs (NSAIDs), and opioid analgesics. Opioids and NSAIDs should be prescribed at the lowest dose and for the shortest possible time. Patients with neuropathic components may receive adjuvant drugs. Phytocannabinoids may play a role when the previous pharmacological treatment fails. Physical methods, including heat, laser, and extracorporeal shock wave therapy, improve local circulation, produce muscle relaxation, and treat the myofascial component. Interventions such as acupuncture and radiofrequency promote peripheral and/or central neuromodulation. Aligning the patient's expectations to the outcomes of the proposed treatments is essential; to do so, we must consider the educational measures, behavioral therapies, and physical rehabilitation.