Recent highlights in low back pain research, Part II: Prevention and management

This paper highlights research relating to the prevention and management of non-specific low back pain (LBP) published between January 2020 and December 2025.

To identify studies for inclusion, MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched. Relevant studies were grouped according to topic area. From those results, studies that were perceived to be of great clinical importance and particularly high quality were selected.

This narrative review synthesised five key themes in contemporary LBP management. Theme 1 (Prevention) demonstrated consistent evidence that exercise-based programs, particularly when combined with education, reduce the risk and impact of recurrent LBP. Theme 2 (Non-pharmacological management) showed that education, exercise, manual therapy, acupuncture and psychologically informed approaches generally produce small to moderate effects on average, with the strongest and most sustained benefits observed for exercise and psychologically informed approaches. In Theme 3 (Pharmacological management), it was found that commonly used medicines provide at best small benefits while carrying meaningful risks, reinforcing their limited and time-restricted role in care. Theme 4 (Invasive and surgical interventions) highlighted that most invasive procedures offer little to no meaningful benefit for LBP and expose patients to substantial harm and cost. Finally, Theme 5 (Special populations) showed that older adults, children, adolescents, and Indigenous and underserved communities remain under-represented in clinical trials and are more likely to receive non-guideline concordant care, emphasising the need for tailored, equity-oriented approaches.

LBP care is most effective when it is active and person‑centred. Education, exercise and psychologically informed approaches should be prioritised, while medicines and invasive procedures offer little benefit and carry risk; care should be tailored to reduce persistent inequities across populations.