Physicians often advise people with low back pain to manage it without expensive or invasive procedures – for instance, by self-monitoring symptoms and learning about their condition.

But according to a review article published recently in Arthritis Care & Research, this kind of self-management does little to improve pain and disability leading the researchers to conclude that people with low back pain may be better off trying other interventions, such as massage, which have been shown to lead to greater improvements.

Australian researchers conducted a meta-analysis of 13 individual studies that compared different treatments for low back pain (LBP). These studies included 3,063 participants with LBP that was not caused by something specific, such as an infection, cancer, fracture, inflammation or osteoarthritis.

The researchers defined self-management (sometimes called self-care) as sharing responsibility for a plan of care and self-monitoring and managing signs and symptoms. People might accomplish this by having discussions with their doctors and using information from sources such as brochures, websites, audiotapes or videotapes.

The meta-analysis found that on a scale of 100 points, individuals who self-managed their LBP had average improvements of only 3.2 points for pain and 2.3 points for disability within the first six months. The improvements were 4.8 points for pain and 2.1 points for disability after a minimum of 12 months.

"With such small improvements, it made us question whether or not managing low back pain on your own was worthwhile," says study co-author Vinicius Cunha Oliveira, a PhD candidate in the faculty of health sciences at the University of Sydney, in Sydney, Australia.

The research showed that self-management either had the same or fewer benefits than other nonmedical interventions, such as massage, acupuncture, yoga and exercise. However, self-management was more effective than a one-hour educational session on pain and disability at short-term follow up (less than six months) and on disability at long-term follow up (at least 12 months).

Finding the best ways to help improve low back pain is important because between 60 and 80 percent of the U.S. adult population has low back pain at some point. According to 2007 guidelines put out jointly by the American College of Physicians and the American Pain Society, LBP is the fifth most common reason for all doctor visits in the United States, with direct health care costs estimated (in 1998) to top $26 billion. These guidelines recommend the use of self-care when there is no serious underlying condition.