Chronic Low Back Pain: Do Lumbar Braces Deliver?

Lumbar supports are widely used for chronic low back pain, but evidence regarding their efficacy remains limited and inconclusive.A Cochrane review of eight randomized controlled trials involving just over 500 adults with chronic low back pain showed lumbar supports generally provided little to no improvement in pain or disability compared with no intervention or usual care.One possible exception was a short-term reduction in pain when lumbar support was added to pain medication, such as ibuprofen. In the pooled analysis, investigators founda 17.66-point greater reduction in pain on a 0-to-100 scale with lumbar support plus medication vs medication alone, although the evidence was low certainty.“Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness,” lead investigator Chiara Arienti, PhD, Humanitas University, in Milan, Italy, said in a statement. “Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for, or against, their use.”The study was published online on September 2 in the Cochrane Database of Systematic Reviews.Limited Evidence for a Common InterventionLow back pain affects hundreds of millions of people worldwide, limiting daily activity and driving substantial demand for rehabilitation. Symptoms lasting longer than 12 weeks are considered chronic and can substantially diminish quality of life.Most cases of low back pain are nonspecific, meaning they cannot be attributed to a clearly identifiable disease or structural cause. Management of chronic cases typically emphasizes active strategies such as exercise, education, and self-management.Lumbar braces and related supports are passive interventions designed to stabilize the spine and reduce strain on the lower back. Although widely used in clinical practice, their benefits and potential harms for chronic low back pain remain uncertain.To assess the benefits and harms of lumbar supports and other assistive devices, the investigators searched electronic databases and trial registries through January 7, 2025. Outcomes of interest included pain, disability, quality of life, treatment success, falls, adverse events, medication use, mood, and participation in social activities.The review included eight randomized controlled trials involving 501 adults aged 25-78 years who had experienced chronic low back pain for 1-5 years. All were treated in outpatient rehabilitation settings. The studies were conducted in Iran, Bangladesh, Turkey, the US, and Japan; five of the eight trials took place in low- and middle-income countries.All eight trials evaluated lumbar supports; none examined mobility or gait devices such as canes, walkers, crutches, wheelchairs, or mobility scooters. Most trials assessed semi-rigid supports used alongside usual care, including pain medication, education, exercise, or physical therapy. Because usual care varied among the studies, the investigators analyzed the comparisons separately.Treatment duration ranged from 3 weeks to 6 months. Participants were instructed to wear the supports for periods ranging from about 4 hours a day to throughout the day, except while bathing or sleeping.The investigators assessed outcomes at the end of treatment and used the Grading of Recommendations Assessment, Development and Evaluation system to rate the certainty of the evidence.Small and Uncertain BenefitsWhen lumbar supports were added to nonsteroidal anti-inflammatory drug (NSAID) therapy, two trials involving 149 participants found that pain scores were 17.66 points lower after 3-4 weeks than with NSAIDs alone (95% CI, -24.22 to -11.09). This exceeded the review’s 15-point threshold for a clinically meaningful difference on the 0-to-100 pain scale, although the evidence was of low certainty.For disability, the point estimate also favored lumbar support plus NSAIDs over NSAIDs alone (SMD, -0.63; 95% CI, -1.43 to 0.17). However, the evidence was of very low certainty, and the CI included the possibility of no benefit.In a separate trial of 107 participants, pain scores at 3 months were eight points lower with lumbar support alone than with no intervention (95% CI, -15.02 to -0.98). Although the difference favored lumbar support, it did not meet the 15-point threshold for clinical significance. Disability scores differed little between the groups (MD, -0.10; 95% CI, -1.11 to 0.91).Findings were mixed when lumbar supports were added to active treatments.In a small study of 25 participants, adding lumbar support to education and exercise was associated with pain scores that were 4.5 points lower after 6 weeks, but the wide CI included no difference (95% CI, -20.98 to 11.98). The effect on disability was also very uncertain (MD, 2.80; 95% CI, -21.58 to 27.18). The trial was stopped early after an interim analysis found worse health-related quality-of-life outcomes in the lumbar-support group.A separate trial of 41 participants found that adding lumbar support to routine physical therapy made little difference in pain after 4 weeks (MD, 3.10; 95% CI, -5.89 to 12.09). Disability scores were 4.27 points lower in the lumbar-support group (95% CI, -7.71 to -0.83), although the evidence was of very low certainty.Evidence Gaps RemainLumbar supports may provide modest short-term pain relief in some circumstances, but the evidence remains limited.The certainty of the evidence was low or very low, largely because the trials were small and brief and had methodological limitations, including a lack of blinding, incomplete outcome data, and selective reporting, the investigators noted.Safety also remains uncertain. None of the studies reported adverse events, falls, or withdrawals related to adverse events, leaving potential short- and long-term harms unclear.The generalizability of the findings may also be limited. Five of the eight trials were conducted in low- and middle-income countries, where access to and affordability of active rehabilitation may differ from those in higher-income settings.“It’s striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access,” senior investigator Stefano Negrini, MD, PhD, professor at the University of Milan, said in a statement.“We have to ask ourselves whether we are looking at this problem only through the lens of the Global North, and whether that is the right perspective.”Disclosure information for study authors is available in the original study publication.