Evidence remains insufficient to support routine use of lumbar braces for chronic low back pain

A new Cochrane review finds very low-quality evidence on lumbar supports for chronic low back pain, meaning that no strong recommendations can be made either for or against their use.

Lumbar supports are inexpensive back or belt braces that stabilize the lower back. They are commonly prescribed and used around the world for chronic low back pain.

Researchers based in Milan, Italy reviewed eight randomized controlled trials involving just over 500 adults aged between 25 and 78 years. The studies compared lumbar supports and other assistive devices, used either on their own or alongside treatments such as pain medication and exercise, with no treatment or standard care.

Not enough evidence to support (or reject) widely-used back braces

Across most comparisons, lumbar supports showed little to no benefit or very uncertain effects, with the possible exception of a small short-term reduction in pain intensity when added to pain medications such as ibuprofen. However, the authors remain cautious about any conclusions from these small, imprecise trials and have rated the overall quality of evidence as very low.

Lumbar supports are widely used in clinical practice despite the fact we know virtually nothing about their effectiveness. Drawing from a very thin research base, we still don’t have enough evidence to make broad recommendations for or against their use.”

Dr. Chiara Arienti, lead author from Humanitas University

No side effects were found across the trials. However, this may reflect missing or underreported data rather than an absence of harm. Nevertheless, the authors consider this finding to be consistent with their clinical experience.

Research concentrated in lower-income countries

One interesting finding was the geographic distribution of the research. The majority of the trials identified were conducted in low- and middle-income countries (LMICs), with researchers from higher-income countries also appearing to have ties to those regions.

The authors suggest this pattern may reflect a disparity in access to treatment. In higher-income countries, clinical guidelines increasingly favour active interventions such as exercise therapy, education, and biopsychosocial approaches for chronic low back pain. In settings where such treatments are less accessible, passive devices like lumbar supports may represent a more readily available option.

“It’s striking that most of the research on lumbar supports is coming from areas where active treatments are harder to access,” says Professor Stefano Negrini, senior author from University of Milan. “There’s enough data now showing that active treatments have a clinical effect on low back pain, but these treatments can be very expensive because they require rehabilitation professionals’ involvement.”

He continues: “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. These devices may play a different and important role in contexts where the alternative simply isn’t available.”

As aging demographics shift the population profile in many countries, demand for accessible, low-cost passive treatments is likely to grow, meaning that current gaps in the evidence could become increasingly consequential.

The authors call for future research to prioritize research into their use among certain populations, particularly older adults and those in lower resource settings, for whom active treatment alternatives may not be readily available.