Nonpharmacologic | Exercise v. no exercise | Small | Moderate (19 RCTs) | Yes, for patients with flare-up (a temporary increase in severity of the ongoing symptoms) | Yes |
| Spinal manipulation v. inert treatment | Small | Low (7 RCTs) | Yes, if part of an exercise program | Yes |
| Cognitive behavioural therapy v. no treatment | Moderate | Low (5 RCTs) | Yes, if part of an exercise program | Yes |
| Behavioural (operant) therapy v. no treatment | Small | Low (3 RCTs) | Yes, if part of an exercise program | Yes |
| Multidisciplinary therapy v. usual care | Moderate | Moderate (9 RCTs) | Yes, if previous treatment not effective or at high risk of poor outcome | Yes |
| Massage v. usual care | No effect | Low (1 RCT) | Yes, if part of an exercise program | Yes |
| Acupuncture v. placebo | Moderate | Low (9 RCTs) | Do not offer | Yes |
| Ultrasonography v. no treatment | No effect | Low (5 RCTs) | Do not offer | Do not offer |
| TENS v. sham treatment | No effect | Low (4 RCTs) | Do not offer | Do not offer |
Pharmacologic | NSAIDs v. placebo | Small | Moderate (6 RCTs) | Yes, if safe, at lowest dose and short term only | Yes, if nonpharmacologic options fail |
| Opioids v. placebo | Small | Moderate† (15 RCTs) (44) | Do not offer | Yes, only as last resort |
| Paracetamol v. placebo | No effect | Very low† (1 RCT) (36) | Do not offer | Insufficient evidence |
| Tricyclic antidepressants v. placebo | No effect | Moderate (4 RCTs) | Do not offer | Do not offer |
| Benzodiazepines v. placebo | Lower likelihood of failure to improve | Low (2 RCTs) | Do not offer | Insufficient evidence |
Injection therapy | Epidural steroid injection v. placebo | No effect | Low† (2 RCTS) (45) | Do not offer | No mention |
| Facet joint steroid injection v. placebo | No effect | Low† (2 RCTS) (45) | Do not offer | No mention |
| Radiofrequency denervation v. sham intervention | Facet: small | Low† (4 RCTs) (14) | Yes, if nonsurgical treatment failed and positive response to medial branch block | No mention |
Surgery | Spinal fusion v. rehabilitation | No effect | Moderate† (4 RCTs) (46) | Do not offer unless as part of a trial | No mention |