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4 Evidence-Based Conservative Options for Chronic Low Back Pain

What does “evidence-based” mean and why is it important?  

There’s a lot of advice out there about the best ways to deal with back pain. So how do you know which advice you can trust? The most reliable information is based wholly on up-to-date, evidence-based research.  

To say research is “evidence-based” is to say it has been tested and verified. Experts set up tests designed to show what is true and what isn’t about an assumption. Then they study and carefully analyze the results. In many cases, other experts in the field also review the research to make sure it is valid. You can trust and use this kind of research for help in making sound choices.  

What follows is the latest evidence supporting conservative options for treating chronic low back pain. 


Chronic, or long-term, pain can be frustrating. If you’re dealing with chronic back pain, you may be at a loss about where to turn next. You may wonder whether surgery, spinal injections, or prescription painkillers might offer a quick fix. Unfortunately, evidence shows that these options don’t have a high success rate in treating chronic low back pain. Sometimes, in fact, they can lead to additional problems.  

So, what kind of care is supported for treating chronic low back pain? Evidence supports conservative options, like self-care, as a good starting point. Self-care is about the activities you can do to help maintain your own health and wellness. It is about learning what you can do to take care of yourself, beyond taking meds and seeing a doctor. It’s also about finding out what works best for you so you can control your pain and keep a positive outlook.  

Here are some key self-care treatments that evidence supports: 
  • Stay active. If your back hurts, you may be afraid that moving too much might make it worse. In fact, the opposite is true. Too much rest and inactivity can prolong the pain or even make it worse. That’s because your muscles can stiffen and grow weak. And joints need movement to stay healthy. The most important thing you can do is keep moving. You don’t need to take part in high-intensity exercises. Walking is a good, simple way to stay active. Modify or pace your daily activities so you don’t feel too much discomfort. And don’t forget, a big part of staying active is making sure you get out and stay engaged with others. Sometimes spending too much time alone thinking about the pain can get you down and possibly worsen the pain.   
  • Educate yourself about pain. There is rarely a simple reason to explain why chronic back pain persists. But studies show that merely learning about how and why it’s there is a helpful starting point. Chronic pain is processed in the brain differently than acute pain. Normally, once an injury heals, pain goes away. But sometimes the brain continues to sense pain even when there’s no longer a reason to. Sometimes chronic pain may likely be due to over-reactive nerves, and not some kind of serious damage. You may find it helpful to learn how your thoughts about pain can ultimately affect how you feel. Therapies like cognitive behavioral therapy can help you change how you think about your pain and how you experience it. 

Exercise therapy 

Evidence also strongly supports safe movement and exercise for chronic low back pain. The focus of the following exercise-based treatments is to keep your back working as it should and to help keep the pain from getting worse. Here are some key recommendations: 
  • Therapeutic exercise: A physical therapist can help you customize exercises that work with your specific pain problems. You’ll also learn exercises that you can do on your own. And you’ll learn proper technique. 
  • Multidisciplinary rehab: This type of treatment focuses on both physical and mental health. Back pain can cause many people to feel frustrated and down. So it can be helpful to treat both aspects of the problem.  
  • Aquatic exercise: Doing exercises in a pool can be helpful if movements on land are too painful.  

Psychological therapies  
It can often be tricky to figure out what’s causing chronic pain. An injury may have been the starting point for the pain. But in time your thoughts can also play a role in how you feel physically. That’s because they can influence how your brain interprets the pain in your body.  

There are treatments that help address this part of chronic pain. They are often used along with other forms of care, like therapeutic exercise and ongoing self-care. The research shows that the following treatments may be helpful in treating chronic pain: 
  • Cognitive behavioral therapy (CBT): The way you think about your pain can actually make it feel better or worse. CBT can help you become aware of your thoughts about pain and how you respond to them. 
  • Progressive relaxation: This is a mind-body therapy that teaches you how to relax your muscles. With practice, relaxation techniques like this can help ease your pain. 
  • Mindfulness-based stress reduction: Mindfulness may include meditation, body awareness, or certain types of yoga. Like CBT, this can help you become more aware of your pain. This can help how you respond to the pain. 
  • Biofeedback: This is a technique you can use to learn to control your body’s functions. Electrical sensors are attached to different parts of your body. The feedback from the sensors helps you learn to make subtle changes, such as relaxing muscles that may be in pain.   

Provider-directed therapy

Research also supports certain treatments that are provider-based. These should be regarded as secondary care. They should also be used along with, not in place of, self-care and general movement. The aim of these treatments is to keep your back working as it should and to keep the pain from getting worse. Research supports the following provider therapies for chronic low back pain: 
  • Therapeutic massage: This therapy may be able help soothe pain by loosening tense muscles in and around the spine and other areas. It may also help restore freedom of movement so you can get back to doing some of your normal day-to-day activities. 
  • Spinal manipulation: By applying force to parts of your spine, a chiropractor may be able to help restore proper movement and function.  
  • Acupuncture: Acupuncture involves temporarily placing very fine needles in certain points of the body. This therapy may help ease pain and allow healing. 
Because chronic pain can be tough to diagnose, it can also be frustrating to manage. Research points to self-care and mind-body approaches like CBT as helpful ways to treat chronic pain. The most effective form of self-care is staying active. Try to make sure you’re moving often and limiting bed rest. But staying active also means getting on with your normal daily activities like going to work and staying social. If you decide to add exercise or work with a provider, be sure to do so along with your self-care treatments. If you weren’t active before your back pain set in, it’s best not to add new types of activities. Stick to what you know and pace yourself. And remember that your outlook affects how you feel. So, try to keep your thoughts positive as you work toward recovery.  

View Credits
Primary Author: Jason Nielsen
Clinical Reviewer: Jossue Ortiz, DC
Final Review and Approval by Jossue Ortiz, DC
--> Date of Annual Review:12/19/2022
Healthyroads' Editorial Staff follow a quality assurance process to help promote each article’s accuracy:
  • A health expert provides input on topic.
  • Scientific evidence from widely accepted health texts, peer-reviewed journals, and other reliable sources is consulted.
  • Final article is reviewed and approved by a health professional.
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