Ultrasound therapy for chronic low back pain | Figure 1

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Ultrasound therapy for chronic low back pain

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Background

It is common for people to feel pain in their lower back. When the cause of pain is unknown, we say that the pain is ‘non‐specific’. Pain that lasts for more than three months is considered to be 'chronic'.

Chronic non‐specific low back pain can be disabling. It can cause people to miss work. Often, people with chronic non‐specific back pain seek medical care.

Ultrasound therapy is the use of sound waves (vibrations) to treat medical problems. It is commonly used to treat low back pain. A healthcare provider rubs a hand‐held machine against the skin on the lower back. The machine produces vibrations that go through the skin. The aim is to deliver heat and energy to body parts under the skin, to reduce pain and speed up recovery.

This Cochrane Review aimed to find out whether ultrasound is effective for treating chronic non‐specific low back pain, and whether it causes any unwanted effects. Specifically, we wanted to know if ultrasound affected the following outcomes: pain, people feeling restricted in their daily life by pain, satisfaction with the treatment, well‐being, disability, and other unwanted effects.

What did we look for?

We looked for studies published up to January 2020 that:

• were randomised controlled trials, medical studies where people are randomly put into one of two or more treatment groups. This type of study provides the most reliable evidence about whether a treatment makes a difference;

• included people with chronic non‐specific low back pain who were aged 18 years or older;

• compared ultrasound (either alone or with another treatment) with a placebo (fake treatment) or other treatments for chronic non‐specific low back pain.

What did we find?

We found 10 studies that included a total of 1025 people treated for chronic non‐specific low back pain.

Most people in the studies had mild to moderate back pain, which means they may have found daily activities painful. They were treated in outpatient hospital departments or clinics, where they typically had six to 18 sessions of ultrasound therapy. Study participants were then followed for a period of time after the treatment (usually a few days or weeks).

Studies compared ultrasound to one or more of the following: placebo (five studies), no treatment (one study), electrical pulses (one study), manipulation of the spine (one study), osteopathy (one study), and laser therapy (one study). Three studies compared ultrasound with exercise to exercise alone. None of the studies was commercially funded.

Key results

There is little to suggest that ultrasound is an effective treatment for people with non‐specific chronic low back pain.

Ultrasound compared with placebo

We do not know whether ultrasound reduces average pain intensity because this has been studied in too few people, in studies that gave varying answers and were poorly conducted. Ultrasound probably makes little or no difference to the number of people in whom pain is reduced by 30% or more in the short term (i.e. less than three months after the start of the study).

Ultrasound probably makes little or no difference to people’s well‐being. It may make little or no difference to how much people feel restricted by their back pain in daily life, or to how satisfied people are with their treatment.

Ultrasound may have little or no impact on unwanted effects. We do not know whether ultrasound affects disability since no studies investigated this.

Ultrasound with exercise compared with exercise alone

We do not know whether ultrasound affects the outcomes of interest in this review because either no studies investigated them, or because the studies that did were imprecise or poorly conducted.

Certainty of the evidence

Based on the studies we found, there was mostly low‐ to very low‐certainty evidence that ultrasound makes little or no difference to pain and well‐being compared to placebo. For all the other outcomes and comparisons, we are less confident in the results we reported. This is because studies were too imprecise or were poorly conducted.

Read the full Cochrane Review here

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