The nurse practitioner provides education about treatments to a 45-year-old woman with a diagnosis of chronic low back pain. Which of the following is NOT considered a first-line treatment for chronic low back pain?

Choice A reason: Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes. Choice B reason: Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management. Choice C reason: Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient. Choice D reason: Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.