Widely used back braces lack strong evidence for chronic low back pain

A new Cochrane review reveals weak evidence on back braces for chronic back pain, indicating no reliable guidance on their use. Lumbar supports, affordable back or belt braces that stabilize the lower back, are frequently prescribed globally for chronic back pain. Researchers from Milan, Italy, analyzed eight randomized controlled trials involving over 500 adults aged 25 to 78.

The trials compared lumbar supports with other assistive devices, used alone or alongside pain medication and exercise, against no treatment or standard care. The results, published in the Cochrane Database of Systematic Reviews, indicate that lumbar supports generally showed little to no benefit or very uncertain effects, except for a minor, short-term reduction in pain when used alongside pain medication like ibuprofen.

However, the authors caution against drawing conclusions from these small, imprecise trials and rate the overall quality of evidence as very low. Dr. Chiara Arienti, lead author from Humanitas University, notes that despite limited research, there is still insufficient evidence to recommend for or against lumbar supports' use. No adverse effects were found, but this might be due to missing or underreported data rather than a lack of harm.

An interesting finding is the geographic distribution of the research, with most trials conducted in low- and middle-income countries (LMICs), while higher-income countries have researchers with ties to those regions. The authors suggest this pattern may reflect a disparity in treatment access, as clinical guidelines in higher-income countries increasingly favor active interventions such as exercise therapy and biopsychosocial approaches for chronic low back pain.

In contrast, passive devices like lumbar supports may be more readily available in settings where such treatments are less accessible. The authors propose that this disparity may be a result of a perspective focused on the Global North, potentially overlooking the role of such devices in contexts where alternatives are unavailable.

As aging demographics shift populations in many countries, the demand for low-cost, accessible passive treatments is likely to increase, making the current gaps in the evidence potentially more consequential. The authors urge future research to focus on the use of lumbar supports and other assistive technologies among specific populations, particularly older adults and those in lower-resource settings, for whom active treatment alternatives may not be readily available.