Little Evidence Back Braces Work for Chronic Low Back Pain
/By Pat Anson
Lumbar supports – also known as back braces – are widely used around the world for low back pain. They’re designed to stabilize the lower back and apply gentle compression to the abdomen, giving relief to sore muscles and aching backs.
There’s also little evidence that they work, according to a new Cochrane review by Italian researchers, who looked at the findings of eight randomised controlled trials involving over 500 adults with chronic low back pain. Five of the studies were conducted in low and middle-income countries and three were in high-income countries.
Researchers found that lumbar supports showed little to no benefit, with the possible exception of a small short-term reduction in pain intensity when used with pain relievers like ibuprofen. The authors were cautious about drawing any further conclusions from the eight trials, and rated the quality of evidence as very low.
“Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness,” says lead author Chiara Arienti, PhD, an Assistant Professor in the Clinical Epidemiology Research Centre at Humanitas University in Milan. “Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for or against their use.”
Arienti and her colleagues say lumbar supports may provide pain relief for three to four weeks when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), but offer little to no benefit when used alone. They were also “very uncertain” about the benefits of lumbar support when combined with exercise and education.
None of the studies tested mobility devices like walking aids or wheelchairs, which could potentially be helpful for older adults and people with disabilities.
Lumbar Supports More Common in Poorer Countries
One interesting finding was the geographic distribution of the research. Most of the trials were conducted in low- and middle-income countries, where lumbar supports are used more routinely.
In higher income countries, patients are more likely to get exercise therapy, education, and cognitive behavioral therapy for chronic low back pain. Those “active” therapies are less likely to be offered in poorer countries.
"It's striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access," says senior author Stefano Negrini, PhD, a Professor in Physical and Rehabilitation Medicine at the University of Milan. “There’s enough data now showing that active treatments have a clinical effect on low back pain, but these treatments can be very expensive because they require rehabilitation professionals' involvement.”
As the population ages around the world, demand for low-cost treatments is likely to grow. The authors say more research is needed in low to middle-income countries to better understand the value of lumbar supports, particularly for older adults who may not have access to other treatments.
“We have to ask ourselves whether we are looking at this problem only through the lens of the Global North, and whether that is the right perspective. These devices may play a different and important role in contexts where the alternative simply isn't available," Negrini said.
Chronic lower back pain is the leading cause of disability worldwide. Over 72 million U.S. adults suffer from it, according to a 2022 Harris Poll. About a third of those surveyed rated their pain as severe and nearly half said they experienced chronic back pain for at least five years.
Although lower back pain is quite common, there is little consensus on how to treat it. Most of the clinical trial evidence is considered low or very low quality, a persistent problem.in many medical guidelines dealing with pain.
