Straight answers about a sore back

Sources

1. The RESTORE trial randomised 492 people with chronic disabling low back pain across 20 primary-care physiotherapy clinics to usual care, cognitive functional therapy, or cognitive functional therapy with movement-sensor biofeedback. Both therapy arms produced a 4.6-point improvement on the 24-point Roland Morris Disability Questionnaire versus usual care at 13 weeks, with similar effect sizes still present at 52 weeks and substantially lower societal costs. Adding the sensor added nothing.

   Kent P, Haines T, O'Sullivan P, et al. — Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial.. The Lancet, 2023. DOI: 10.1016/S0140-6736(23)00441-5.

2. A network meta-analysis of 97 randomised trials and 13,136 participants found psychological interventions for chronic low back pain work best when delivered ALONGSIDE physiotherapy care rather than instead of it: cognitive behavioural therapy and pain education with physiotherapy produced clinically important improvements in physical function, and behavioural therapy with physiotherapy was the only combination that maintained clinically important pain reduction to mid-term follow-up.

   Ho EK, Chen L, Simic M, et al. — Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2021-067718.

3. The Cochrane review of exercise therapy for chronic low back pain pooled 249 trials and found moderate-certainty evidence of a clinically important 15.2-point pain reduction (0-100 scale) versus no treatment, usual care or placebo. The effect on functional limitations was 6.8 points, which did NOT meet the review's own threshold for a minimal clinically important difference, and adverse effects were mostly minor muscle soreness.

   Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW — Exercise therapy for chronic low back pain.. Cochrane Database of Systematic Reviews, 2021. DOI: 10.1002/14651858.CD009790.pub2.

4. The 2025 ASIPP regenerative-therapy guideline for chronic low back pain - written by the specialty society that performs these procedures - grades the evidence as Level III (fair) for intradiscal PRP, Level III (fair) for intradiscal bone marrow concentrate, Level III (fair) for epidural PRP, Level IV (limited) for facet joint PRP and MSC injections, Level IV (limited) for sacroiliac joint PRP, and very low for functional-spine-unit injections. All 19 recommendations are consensus-based rather than evidence-driven, the panel names the scarcity of high-quality studies as the primary limitation, and it states that most of these therapies are not covered by commercial insurance.

   Manchikanti L, Navani R, Navani A, et al. — Comprehensive Evidence-Based Guidelines for Regenerative Therapies in the Management of Chronic Low Back Pain: 2025 Update from the American Society Of Interventional Pain Physicians (ASIPP).. Pain Physician, 2025.

5. The FDA states verbatim that stem cell products, stromal vascular fraction, umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been 'approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' No stem cell product is approved in the United States for any orthopedic use: the only ones with FDA approval at all are blood-forming cells derived from umbilical cord blood, approved solely for disorders of blood production, and there are currently no FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes.. FDA.gov, 2025.