That's according to a new study review published in the journal BMJ Evidence-Based Medicine that analyzed 301 rigorous trials of 56 treatments or treatment combinations to see which ones made low back pain less intense.

"It was surprising to see so few treatments were effective and that when effective, the benefits were mostly modest," said study author Aidan Cashin, PhD, deputy director of the Center for Pain IMPACT at Neuroscience Research Australia.

Treatments that worked: For acute low back pain, nonsteroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen, diclofenac, or naproxen – brought some relief. For chronic back pain lasting 12 weeks or more, the most helpful treatments were exercise, spinal manipulative therapy, taping, antidepressant medication, and capsaicin patches. But all of these treatments reduced pain by only four to eight points on a 100-point scale.

Treatments that didn't work: For acute low back pain, exercise, glucocorticoid (cortisone) shots, and acetaminophen were not effective. For chronic back pain, antibiotics and anesthetics, such as lidocaine, didn't help. For other treatments, the evidence was inconclusive.

Why Back Pain Persists

Back pain may be the top cause of disability worldwide, affecting 619 million people, research shows.

The reason it's so hard to treat comes down to the "many possible contributors that could be causing and maintaining an individual's back pain experience," Cashin said. If the treatment doesn't address the root cause, then the pain can continue or come back.

Back pain comes in two broad categories, specific and nonspecific. Specific back pain is linked to changes in the body, like a spinal fracture or a narrowing of the spinal canal. But the vast majority of cases – 85% to 95% – are nonspecific, meaning no single cause can be reliably identified, said Cashin. 

"It's important for people experiencing low back pain to consult with an appropriate clinician to identify the type of low back pain being experienced and work together to see which treatments may be appropriate for them," he said.

What to Do

A good start for treating nonspecific low-back pain, Cashin said: a short course of NSAIDs, a discussion with your health care provider about how back pain typically gets better, and a plan for getting back to moving, working, and doing social activities gradually. (Talk to your doctor before starting an NSAID. They're not safe if you have certain health problems, like a history of bleeding in your gut or heart conditions.)

Pain that lasts weeks or months might call for a different solution. Anti-inflammatories can mask pain, but they don't treat the root problem. 

"The name of the game, if you have a patient who has pain anywhere, is to find the cause and to treat the cause," said Helene Bertrand, MD, a retired family medicine doctor and clinical instructor for the Department of Family Practice at the University of British Columbia. 

For example, many people with back pain have dysfunction in the sacroiliac joints that connect the spine and pelvis. Sitting all day puts pressure on these joints. Bertrand recommends simple exercises to correct misaligned sacroiliac joints. They were found to be effective in a pilot study.

When back pain persists after more conservative treatments, interventional therapy often comes next. These more invasive options include treatments such as radiofrequency ablation to disrupt nerves, an implantable spinal cord stimulator, or surgery to correct anatomical problems.

"We know from multiple studies that medical management does not work long-term, with only about 9% of people responding with good pain relief and improved function to non-interventional options," said Timothy Deer, MD, a clinical professor of anesthesiology at West Virginia University and founder of the Spine and Nerve Center of the Virginias.

Your doctor might recommend multiple treatments based on your specific condition. Magnetic resonance imaging (MRI) tests can help guide treatment by revealing spine, disk, or nerve problems. Say, for example, a 40-year-old has degenerative disk disease, loss of function, weight gain, and a history of psychological trauma. Treatment might be a mix of physical therapy, counseling, and then more invasive treatments targeting disks.

"You take all those things together," he said. "The best thing is to hand-pick the best therapy for the patient."