Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.63231/2595-0118.202664-en
Brazilian Journal of Pain
Artigo de Revisão

Non-surgical advanced therapies for chronic low back pain in adults: systematic review of randomized controlled trials

Terapias avançadas não cirúrgicas para dor lombar crônica em adultos: revisão sistemática de ensaios clínicos randomizados

Gabrielly Santos Pereira; Gabrielly Nogueira dos Santos; Gabrielle Vitória Costa; Izadora Reis Silva; Marcelo Lourenço Silva

http://dx.doi.org/10.63231/2595-0118.202664-en BrJP, vol.9, e202664, 2026
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Abstract

BACKGROUND AND OBJECTIVES: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with complex neurobiological and psychosocial mechanisms that often limit the effectiveness of conventional treatments. Recent advances in non-surgical interventions—such as neuromodulation, regenerative therapies, and multimodal physiotherapy—offer promising alternatives for pain modulation and functional recovery. The objective of this study was to systematically review the evidence from randomized controlled trials (RCTs) evaluating the efficacy and safety of advanced non-surgical therapies for CLBP in adults.

CONTENTS: Searches were conducted in Pubmed, Scopus, Web of Science, and ScienceDirect (2015–2025). Eligible studies included RCTs assessing non-surgical interventions such as restorative neurostimulation, spinal cord stimulation, neuromodulation (TENS, rTMS, tDCS, rPMS, taVNS), regenerative biologic injections (PRP, MSCs), and multimodal physiotherapy programs. Primary outcomes were pain intensity and functional disability; secondary outcomes included quality of life and adverse events. Twenty-two RCTs encompassing over 4,000 participants met inclusion criteria. Restorative and spinal cord stimulation demonstrated clinically meaningful pain and disability reductions (up to −19.7 Oswestry Disability Index (ODI) points; ≥60% responder rates). Regenerative therapies with PRP and MSCs achieved long-term improvements lasting up to 36 months with excellent safety profiles. Multimodal physiotherapy programs improved quality of life and function, while non-invasive neuromodulation yielded consistent short-term analgesic benefits. Across studies, adverse events were rare and mild.

CONCLUSION: Advanced non-surgical therapies are effective and safe for managing CLBP, particularly when integrated within multimodal, mechanism-based rehabilitation programs. Combining physiotherapy, neuromodulation, and regenerative approaches may optimize neuroplastic and functional recovery. Further large-scale RCTs with standardized protocols and long-term follow-up are warranted to consolidate these findings.

Keywords

Chronic low back pain; Neuromodulation; Physiotherapy; Platelet-rich plasma; Regenerative therapy; Spinal cord stimulation

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor lombar crônica (DLC) é uma das principais causas de incapacidade em todo o mundo, apresentando mecanismos neurobiológicos e psicossociais complexos que frequentemente limitam a eficácia dos tratamentos convencionais. Avanços recentes em intervenções não cirúrgicas oferecem alternativas promissoras para a modulação da dor e a recuperação funcional. O objetivo deste estudo foi revisar sistematicamente as evidências provenientes de ensaios clínicos randomizados (ECRs) que avaliaram a eficácia e a segurança das terapias avançadas não cirúrgicas para o tratamento da DLC em adultos.

CONTEÚDO: As pesquisas foram realizadas no Pubmed, Scopus, Web of Science e ScienceDirect (2015–2025). Foram incluídos ECRs que avaliaram intervenções não cirúrgicas, como neuroestimulação restaurativa, estimulação da medula espinhal, neuromodulação (TENS, rTMS, tDCS, rPMS, taVNS), injeções biológicas regenerativas (PRP, CTMs) e programas multimodais de fisioterapia. Os resultados primários foram a intensidade da dor e a incapacidade funcional; os resultados secundários incluíram a qualidade de vida e os eventos adversos. Vinte e dois ECRs, envolvendo mais de 4.000 participantes, atenderam aos critérios de inclusão. A estimulação restaurativa e a estimulação da medula espinhal demonstraram reduções clinicamente significativas na dor e na incapacidade (até -19,7 pontos no Índice de Incapacidade de Oswestry (ODI); =60% de taxa de resposta). As terapias regenerativas com PRP e CTMs promoveram melhoras duradouras por até 36 meses, com excelente perfil de segurança. Programas multimodais de fisioterapia resultaram em melhora da qualidade de vida e da função, enquanto as técnicas de neuromodulação não invasiva proporcionaram benefícios analgésicos consistentes a curto prazo. Em todos os estudos, os eventos adversos foram raros e leves.

CONCLUSÃO: As terapias avançadas não cirúrgicas são eficazes e seguras para o manejo da DLC, especialmente quando integradas em programas de reabilitação multimodais e baseados em mecanismos fisiopatológicos. A combinação de fisioterapia, neuromodulação e abordagens regenerativas pode otimizar a recuperação neuroplástica e funcional. São necessários mais ECRs de larga escala, com protocolos padronizados e acompanhamento a longo prazo, para consolidar esses resultados.

Palavras-chave

Dor lombar; Estimulação magnética transcraniana; Estimulação transcraniana por corrente contínua; Plasma rico em plaquetas; Medicina regenerative; Estimulação da medula espinal

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