Degenerative disease of the lumbar spine (ICD-11 FA80.8 / ICD-10 M51.3) is a common source of both acute and chronic low back pain. First-line management is conservative, following a structured stepwise approach to relieve pain and restore function.
The initial strategy is conservative and includes oral analgesic therapy guided by a recognised stepwise framework, combined with active physical interventions — the full regimen, criteria, and sequencing are detailed in the structured protocol.
The first line of treatment is certainly conservative.
In practice, this generally means the prescription of oral analgesics according to the stepwise approach of the WHO (the "analgesic ladder").
It was concluded in two Cochrane reviews that non-steroidal anti-inflammatory drugs (NSAIDs) alleviate both acute and chronic back pain.
Deyo et al. also concluded that opioids alleviate chronic back pain over the short term, but no studies are available on opioid administration for longer than four months.
Physical therapy for acute back pain was classified as ineffective by Karlsson et al. in a systematic review, while active exercise programs are recommended in multiple guidelines for the treatment of chronic low back pain.
Coulter et al. found a moderate degree of evidence favoring manual therapy over active exercise programs for the treatment of chronic back pain: in an inverse Revman model, the standardized mean difference was –0.43, with high heterogeneity ([–0.86 to 0.00]; p = 0.05, I² = 79%).
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