Visit my blog:
Complementary and Alternative
Medicine: Fair and Balanced
My aching back: A national concern
Acupuncture and chiropractic manipulation
are among the more effective treatments for low back pain.
By John Russo Jr./Vicus.com
VICUS.COM (15 Aug. 2000) -- Low
back pain afflicts 60% to 80% of Americans at some time during their
lives, statistics indicate.
Here are some statistics about back pain that may make your head
- Up to half of all Americans suffer from low back pain each year.
- Low-back symptoms are the second-most common reason to visit a
doctor (after the common cold).
- The estimated cost of medical care for those disabled by severe
back pain range from $30 billion to $70 billion annually,
according to a September 1999 statement released by the National
Institutes of Health.
The good news is that despite the common occurrence of acute low
back pain, the incidence of serious disease is very low --
approximately 1% of the population. The most common causes include
compression fracture (4%), spondylolisthesis (3%), malignancy (0.7%),
ankylosing spondylitis (0.3%) and vertebral osteomyelitis (0.1%). But
in most cases (~80%), the exact cause is never discovered.
What works, and
Patients with low back pain who present with so-called "red
flag" (click on "red flag" for chart) may be at
risk of serious disease and require further medical evaluation and
Patients who do not have any "red flag" symptoms during
the history and physical examination may be treated
conservatively. For those with acute low back pain, most will improve
within six weeks.
- There is no evidence that corsets, bed rest,
transcutaneous electrical nerve stimulation (TENS), or traction
have a significant impact on the course of acute low back pain,
although some people believe these therapies help relieve their
pain. Treatment usually consists of muscle relaxants (which act
more like tranquilizers and probably don't relax the specific
tense or spastic muscles), anti-inflammatory drugs and physical
- Conventional medicine also appears to have little to offer in
the treatment of chronic low back pain besides muscle relaxants,
anti-inflammatory medicine, physical therapy and surgery. None of
these are particularly effective.
- Osteopathic manual therapy can be effective in the hands of an
experienced practitioner. A recent publication found that this
therapy had, as its primary benefit, a reduction in the use of
analgesics, anti-inflammatory agents and muscle relaxants (Andersson, et
al., 1999). Surgery is effective in selected cases but it can
carry the risk of causing more pain than it relieves.
treatments for low back pain
Acupuncture and chiropractic manipulation are among
the more effective treatments for low back pain. In addition, the
results of a recent study of massage to treat chronic low back pain appear encouraging.
- Most studies with acupuncture are difficult to evaluate because
of problems with study design. However, a recently published
randomized controlled trial of 20 patients with low back pain
lasting at least one month concluded that after 10 sessions of
individualized acupuncture from a traditional acupuncturist,
significant improvement was reported (MacPherson, et
al., 1999). Patients reported reduced pain intensity,
and improved daily living, physical functioning and mental health.
Other studies have demonstrated growing evidence for the
effectiveness of acupuncture in low back pain (van Tulderetal,
- In a comparison of spinal manipulation, acupuncture and
medication (the non-steroidal anti-inflammatory drug, tenoxicam
with ranitidine (Zantac) for chronic (greater than 13 weeks in
duration) spinal pain syndromes, spinal manipulation was the only
intervention that achieved statistically significant improvement
in pain and disability (Giles and Muller, 1999).
- Massage outperformed acupuncture and state-of-the-art self-care
education in a randomized trial of 262 patients. After 10 weeks,
massage was superior in terms of patient function. In two other
outcomes (satisfaction with care and reduced symptoms), both
massage and acupuncture got higher marks than self-care. However,
after a year, the acupuncture group didn't fare as well, having
significantly worse symptoms and lower function scores than the
massage or self-help group, according to the study results (Jancin,
Medical treatment for acute low back pain is not very effective.
However, one good reason to seek medical attention is to make sure
that what appears to be a bothersome but transient condition is not,
in reality, a more serious condition.
Chiropractic is useful for acute back pain and can help in the
management of chronic back pain as well. It is usually clear whether
chiropractic will work within six sessions. If there is improvement,
up to three more months of treatments may be helpful.
Acupuncture may be used alone or combined with chiropractic. Since
they work by different mechanisms, there is logic in combining
therapies. As with chiropractic therapy, it should be clear after six
sessions if acupuncture is helping. If so, additional treatments may
Massage seldom produces dramatic relief of back pain. However,
positive results presented recently during a conference on
complementary and alternative medicine at Stanford University are
encouraging. Other considerations for the treatment of low back pain
include movement therapy such as Feldenkrais movement
therapy and Rolfing. Both techniques address abnormalities in
movements that may contribute to back pain.
Russo, Jr., PharmD , is senior vice president of medical
communications at Vicus.com. He is a pharmacist and medical writer
with more than 20 years of experience in medical education.
This article was updated on 15 Aug. 2000.
Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans
S. A comparison of osteopathic spinal manipulation with standard care
for patients with low back pain. N Engl J Med. 1999;
Bratman S. The Alternative Medicine Ratings Guide: An
Expert Panel Ranks the Best Treatments for Over 80 Conditions. Prima
Health, Rocklin (CA): 1998.
Cypress BK. Characteristics of physician visits for back symptoms:
a national perspective. Am J Public Health. 1983;
Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988;
Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot
trial comparing acupuncture, a nonsteroidal anti-inflammatory drug,
and spinal manipulation. J Manipulative Physiol Ther. 1999;
MacPherson H, Gould AJ, Fitter M. Acupuncture for low back pain:
Results of a pilot study for a randomized controlled trial. Complement
Ther Med 1999; 7(2):83-90.
Massage vs. acupuncture in treatment of low back pain. Family
Practice News, 1999 Nov. 15.
Preyde M. Effectiveness of massage therapy for subacute low back
pain: a randomized, controlled trial. CMAJ. 2000 Jun 27;
Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the
lumbar intervertebral disk: Clinical considerations for the doctor of
chiropractic. J Manipulative Physiol Ther. 1999:
van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The
effectiveness of acupuncture in the management of acute and chronic
low back pain. A systematic review within the framework of the
Cochrane Collaboration Back Review Group. Spine 1999;