Effective Conservative Treatment for Chronic Low Back Pain
Section snippets
RCTs of Lumbar Spine Fusion vs Cognitive Intervention With Exercise
The effectiveness of lumbar spine fusion vs community based nonoperative treatment was established in an RCT by Fritzell et al.3 Their study found greater reduction of both pain and disability at 2 year follow-up in the lumbar spine fusion subjects compared with subjects randomized to nonoperative care. This study was criticized because of the lack of standardized nonoperative treatment, and more specifically, the omission of aggressive exercise based therapies that had shown some effectiveness
RCTs Examining the Components of Intense Rehabilitation as Treatment for LBP
For the practicing spine surgeon, optimizing patient selection for surgical procedures, maintaining surgical competence, maximizing procedural skills, and supervising postoperative care are tasks that consume all available professional time. Developing and supervising multidimensional rehabilitation programs, such as “cognitive intervention with exercise” or “intensive spine rehabilitation” would seem to be unfeasible additional professional tasks. For some surgeons, medical associates are
Research Comparing the Types of Exercise Used for the Treatment of Chronic LBP
For the treatment of chronic LBP, the convictions of some physical therapists and physicians about specific methods of exercise rival the devotion of some surgeons to particular surgical techniques. The studies that we have reviewed to this point have used a variety of exercise techniques, often in combination, to accomplish their therapeutic goals. The common thread in all of these studies is that exercise should be intense enough to accomplish physiological goals, and presented in such a way
Summary and Conclusion
Effective conservative treatment of the multifaceted problem of chronic LBP holds as many challenges as does surgical treatment of this disorder. Although surgical treatment is primarily focused on the alteration of structures perceived to be the sources of pain, conservative treatment instead aims to improve patients' ability to function with or without concurrent improvement in pain. Most of the scientifically studied conservative treatment programs that are designed to accomplish this task
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Dr Suri is supported by the Rehabilitation Medicine Scientist Training K12 Program (RMSTP) and the National Institutes of Health (K12 HD 01097).
None of the authors have any conflict of interest regarding the contents of this article.