So how do the American and Australian guidelines square up? Roger Chou, MD, associate professor of medicine at Oregon Health and Science University in Portland and the co-author of the 2007 American guidelines, says there aren't major differences between the two country's guidelines. "Both recommend self-care and discourage invasive treatments and extensive testing for most people with LBP," Dr. Chou says.

However, the American guidelines defined self-care more broadly, and included interventions such as staying active, using warm packs, taking over-the-counter medications such as anti-inflammatory drugs, and doing home exercise programs. "None of these were included in the Australian [review article], even though there is evidence that they are helpful," Dr. Chou says.

Dr. Chou adds that, even though the benefits of self-management are small, he believes it is worthwhile because it is non-invasive and inexpensive. In addition, he says, there are very few effective interventions for LBP. "Even drugs that relieve pain only have an average of 10 to 20 points of improvement on a 100-point pain scale," Dr. Chou says. "So even if there is only a small effect, it still might be worthwhile."

Because national guidelines for low back pain strongly encourage it, the Australian authors were surprised that such little research had been done on self-management. "We found very few trials that tested self-management for low back pain," Oliveira says. "We were also surprised by the programs tested because they did not seem like the best choices. Better programs could produce better results."

Although its benefits appear to be small, Oliveira says he doesn’t think that people should stop self-managing their low back pain. Instead, more research should be done to see if any specific aspects of self-management might be more effective than others, such as group discussion or long-term follow-up sessions with doctors.

Other than self-care, what can patients with LBP do to feel better? "We know that staying active helps people recover faster than if they rest in bed," Dr. Chou says. "We also know that warm packs, over-the-counter medications, and home exercise programs can help with symptoms."

"The most important thing is to keep moving, if possible, and to understand that most LBP will get better without expensive or invasive treatments," Dr. Chou concludes.