Putra Berry H, Sinuraya Rano K, Suwantika Auliya A
Master of Pharmacy Program, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.
J Pain Res. 2025 Sep 5;18:4599-4610. doi: 10.2147/JPR.S551372. eCollection 2025.
Low back pain (LBP) is a leading cause of global disability, with a 7.2% prevalence and up to 80% lifetime risk, substantially impairing functionality and imposing a major economic burden. This review evaluates the cost-effectiveness trade-offs between pharmacological and non-pharmacological therapies for non-specific LBP, drawing on recent, high-quality evidence from a comprehensive PubMed search. Evaluated approaches included physical therapy, pharmacological management, cognitive behavioral therapy (CBT), chiropractic manipulation, acupuncture, yoga, and massage therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) remain widely prescribed, yet their safety concerns contrast with the more sustainable benefits of physical therapy and spinal manipulation, with specialized physical therapy yielding 74% greater improvement than conventional therapy combined with NSAIDs. Nevertheless, physical therapy faces limitations related to practitioner variability, accessibility in rural or low-resource settings, upfront costs, and patient adherence. CBT demonstrates significant psychosocial benefits but is constrained by limited availability of qualified practitioners, high costs, and the active participation required from patients. Complementary approaches such as acupuncture and yoga show moderate efficacy and potential economic benefits; however, evidence consistency, delivery infrastructure, and adherence remain challenges, with yoga in particular showing high dropout rates in low-resource contexts. Importantly, acupuncture and yoga may still provide valuable benefits as part of a multimodal strategy. However, the available evidence is heavily concentrated in high-income countries, while studies from low- and middle-income countries remain scarce and unevenly distributed. Only a few LMICs have reported findings, with particularly limited data from Southeast Asia, underscoring critical research gaps in these regions. No single therapy emerges as universally superior for non-specific LBP, as effectiveness depends on patient profile, healthcare context, and cost. These findings highlight the importance of integrated, scalable, and accessible multidisciplinary models aligned with the biopsychosocial framework to optimize long-term outcomes.
腰痛（LBP）是全球残疾的主要原因，患病率为7.2%，终生风险高达80%，严重损害功能并带来重大经济负担。本综述利用全面的PubMed搜索中最近的高质量证据，评估了非特异性腰痛的药物治疗和非药物治疗之间的成本效益权衡。评估的方法包括物理治疗、药物管理、认知行为疗法（CBT）、整脊推拿、针灸、瑜伽和按摩疗法。非甾体抗炎药（NSAIDs）仍然广泛使用，但其安全性问题与物理治疗和脊柱推拿更可持续的益处形成对比，专业物理治疗比传统治疗联合NSAIDs的改善效果高74%。然而，物理治疗面临与从业者差异、农村或资源匮乏地区的可及性、前期成本以及患者依从性相关的限制。CBT显示出显著的心理社会益处，但受到合格从业者可用性有限、成本高以及患者需要积极参与的限制。针灸和瑜伽等补充疗法显示出中等疗效和潜在经济效益；然而，证据的一致性、实施基础设施和依从性仍然是挑战，特别是瑜伽在资源匮乏环境中的辍学率很高。重要的是，针灸和瑜伽作为多模式策略的一部分仍可能提供有价值的益处。然而，现有证据主要集中在高收入国家，而来自低收入和中等收入国家的研究仍然稀少且分布不均。只有少数低收入和中等收入国家报告了研究结果，东南亚的数据尤其有限，凸显了这些地区的关键研究空白。对于非特异性腰痛，没有一种疗法被证明普遍优于其他疗法，因为疗效取决于患者特征、医疗环境和成本。这些发现强调了与生物心理社会框架相一致的综合、可扩展和可及的多学科模式对于优化长期结果的重要性。
