WebMD Health - Back Pain

Apr 13, 2010 7:25 PM

Alternative Approaches to Low Back Pain

Have you ever had back pain? If so, you're not alone. About 8 out of every 10 people have acute (sudden) or chronic (long-lasting) back pain at some point in their lives.

Most acute back pain goes away on its own, whether or not you treat it with medication or other therapies.

But sometimes it doesn't.

You might think that if you have chronic low back pain -- pain that lasts longer than about six to eight weeks -- that you'll need medication, surgery, or both to help get relief.

But there are dozens of alternative treatments for chronic back pain that don't involve taking medication or having an operation. And many of them are much more popular.

"Americans spend much more out of pocket for alternative pain therapies than they will for traditional treatments," says Barry Cole, MD, director of the American Society of Pain Educators. "People value these treatments enough to pay cash!"

Some alternative approaches to back pain are more established than others, and some have more scientific evidence supporting them. Here is an overview.

Physical Therapy for Back Pain

The right kind of physical therapy can often curb chronic back pain.

"When you visit a physical therapist, there are a number of things they might do," says Sam Moon, MD, MPH, of Duke Integrative Medicine, part of Duke University Medical Center. "They might use machines or traction, they might put you through stretching exercise, or they might use hands-on techniques."

Moon says the types of physical therapy shown to be most helpful for chronic back pain are hands-on soft tissue mobilization -- in which the therapist moves the soft tissues of your back -- and education about posture and home exercise.

Effective physical therapy should always include learning what to do at home -- and then doing it.

Getting physical therapy twice a week and then sitting in your usual bad posture, or avoiding exercise, won't help. Physical therapy should be goal-oriented and "shouldn't go on forever," Moon says.

Chiropractic/Spinal Manipulation

Doctors of chiropractic use their hands, and sometimes other tools, to manipulate the joints of the body -- particularly the spine -- to help relieve pain.

Studies have shown that chiropractics can be effective in relieving acute (sudden) and chronic back pain, although there's more evidence to support its use in acute back pain.

"Chiropractic is generally considered to be as good as physical therapy, and as good as patient education, in relieving back pain," Moon says. "And, like physical therapists, chiropractors can be very good educators about back health."

Just as with physical therapy, chiropractic care for back pain should involve learning exercises to do at home to strengthen your back, and treatments shouldn't go on forever.

"They should be teaching the patient how to take care of themselves," Moon says. "I won't write an open-ended prescription for chiropractic; generally, I think it should be done for a month or two before re-evaluating how the patient is doing."

Acupuncture for Back Pain

Acupuncture for back pain involves inserting very thin needles into specific points on your body. This traditional Chinese therapy is thought to balance the flow of energy in your body.

Acupuncture is generally considered to be very safe, and Moon commonly recommends acupuncture for back pain.

"There is definitely some evidence that it's effective, although the evidence is even better for other pain conditions, like knee pain from arthritis and tennis elbow," Moon says. "When I recommend acupuncture, I start the patient out with a series of four to five initial treatments, just to see if this person is an acupuncture responder."

Therapeutic Massage for Back Pain

Certain types of massage can help relieve back pain.

"I think there's enough [evidence] to advocate its use to help with low back pain," Moon says. "I wouldn't recommend it by itself, but combined with other approaches, I think it can be useful."

Mind-Body Therapies for Back Pain

Techniques fit under the umbrella of mind-body therapies for back pain, including:

  • Guided imagery
  • Hypnosis
  • Biofeedback
  • Relaxation therapy
  • Talk therapy

Some are harder than others to test scientifically, and it's hard to pinpoint if one type of mind-body therapy is more effective than another. But in general, research has shown that these kinds of therapies can be effective in treating back pain.

"For persistent back pain, I almost always recommend some type of mind-body therapy," Moon says. Which kind? It depends on what kind of therapy appeals to you, as well as what's most easily available in your area.

Mindful Movement

Another category of treatments for back pain is called mindful movement.

These therapies include common options found in many gyms, like yoga and t'ai chi, and other movement-based therapies like the Alexander technique and the Feldenkrais technique. All involve using different positions and types of movement to help relieve your back pain.

"The jury is still out on these techniques," Moon says. "There are some studies that say that they do help with back pain, and some that say they don't. But there is no strong evidence against them, and I have seen these techniques be effective, especially for people who have habits of moving their bodies in ways that can lead to pain."

Finding Treatment

If you want to try chiropractic, biofeedback, massage, or yoga for your back pain, referrals are the best way to find help, Cole says.

"If you have a good relationship with your primary care doctor, they've seen thousands of patients a year and they learn about resources in your community," he says. "Or ask your neighbor, or someone at your gym. Someone else who might not come to mind right away: a hospital social worker. They know a lot about resources in the community. And they can at least tell you who not to go to -- bad news travels fast!"