Structured Abstract
Background/Objectives
Chronic low back pain (CLBP) affects 20-30% of adults worldwide, imposing substantial socioeconomic burdens. Non-pharmacological interventions, such as exercise and mindfulness, show promise but evidence on their comparative efficacy remains fragmented. This systematic review aimed to synthesize randomized controlled trial (RCT) data on non-drug therapies for CLBP, evaluating pain reduction, functional improvement, and long-term outcomes to guide clinical recommendations.
Methods
We conducted a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science from inception to March 2023, using terms like "low back pain," "exercise," "mindfulness," and "non-pharmacological." No language restrictions applied. Inclusion criteria encompassed RCTs of adults with CLBP (duration >3 months) comparing non-drug interventions to usual care or sham controls, with outcomes including pain intensity (VAS scale) and disability (Oswestry Disability Index). Two reviewers independently screened titles/abstracts, extracted data, and assessed risk of bias using Cochrane RoB 2.0. Meta-analysis employed random-effects models in RevMan 5.4, with heterogeneity via I² statistic; GRADE assessed evidence certainty.
Results
Of 1,856 records, 45 RCTs (n=5,128 participants) met criteria, primarily evaluating exercise (n=22), mindfulness-based interventions (n=12), and multimodal approaches (n=11). Exercise yielded moderate pain reductions (SMD -0.58, 95% CI -0.75 to -0.41; I²=62%) at 6 months, superior to usual care. Mindfulness showed small-to-moderate effects on disability (SMD -0.42, 95% CI -0.60 to -0.24; I²=45%). High heterogeneity arose from intervention variability; 60% of studies had low risk of bias. Adverse events were rare (2-5%).
Conclusions
Non-pharmacological therapies, especially exercise, offer robust benefits for CLBP management, reducing reliance on opioids and enhancing quality of life. Future trials should prioritize standardization and diverse populations. These findings support integrating such interventions into primary care, potentially alleviating global healthcare costs.
Keywords
Low back pain; non-pharmacological interventions; exercise therapy; mindfulness; systematic review; meta-analysis
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