Letícia Soares Fonseca, Juliana Pereira Silva, Mateus Bastos Souza, Mariana Gabrich Moraes Campos, Rodrigo de Oliveira Mascarenhas, Hytalo de Jesus Silva, Leani Souza Máximo Pereira, Murilo Xavier Oliveira, Vinicius Cunha Oliveira

September 2023, Volume 32, Issue 9, pp 3245 - 3271 Review Article Read Full Article 10.1007/s00586-023-07857-4

First Online: 18 July 2023

Background and Purpose

The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain.


Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach. Results and Discussion: Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] =  − 1.38 [95% CI − 2.02 to − 0.73]); low-quality evidence that mixed exercise (MD = − 50.33 [95% CI − 57.11 to − 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = − 8.26 [95% CI − 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86–2.86]).


The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies—both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.

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