Cashin and his team found that only NSAIDs seemed to be effective over placebo for acute back pain, while five appeared to work for chronic back pain. These were: exercise, spinal manipulation (which is often associated with chiropractors, but can be performed by physical therapists or osteopaths), taping, antidepressants, and a class of drugs that reduce our sensitivity to pain called TRPV1 agonists (the primary ingredient responsible for a chili pepper’s burning sensation, capsaicin, is one such agonist). Other treatments that failed to meet the threshold for success included cannabinoids, muscle relaxants, opioids, acupuncture, and dry cupping.

Unfortunately, even the top-performing remedies were pretty mediocre. The researchers only had moderate certainty in the data supporting any of these treatments, and their overall effectiveness was judged to be modest at best.

“The current evidence shows that one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, providing only small analgesic effects beyond placebo,” they wrote.