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

Why This Matters

Low back pain management spans prevention, exercise, education, medications, psychologically informed care, invasive procedures, and surgery. Clinicians must decide which approaches are most likely to provide meaningful benefit while limiting unnecessary risk, cost, and low-value care.

This narrative review examined clinically important research published from January 2020 through December 2025. Across five major themes, the evidence consistently favored active, person-centred management, particularly exercise, education, and psychologically informed approaches, while highlighting the limited benefits and potential risks of many medications and invasive interventions.

The review also identifies an important evidence gap: older adults, children, adolescents, and Indigenous and underserved communities remain under-represented in clinical trials and may be more likely to receive care that is not guideline concordant.

What the Research Found

This narrative review searched MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews for research on prevention and management of non-specific low back pain published between January 2020 and December 2025. Studies considered particularly clinically important and high quality were organized into five major themes.

KEY POINTS

• Exercise-based prevention programs reduce recurrent low back pain risk and impact. Benefits were particularly consistent when exercise was combined with education.
• Active non-pharmacological approaches provide the strongest sustained benefits. Education, exercise, manual therapy, acupuncture, and psychologically informed care generally produced small to moderate average effects, with exercise and psychologically informed approaches showing the strongest and most sustained benefits.
• Commonly used medications provide limited benefit. The review found that pharmacological treatments generally offer, at best, small improvements while carrying meaningful risks, supporting a limited and time-restricted role.
• Most invasive procedures provide little meaningful benefit for non-specific low back pain. The review emphasized limited benefit alongside substantial potential harm and cost.
• Important populations remain under-represented in research. Older adults, children, adolescents, and Indigenous and underserved communities have less representation in clinical trials and are more likely to receive non-guideline-concordant care.