Alternative Approaches to Low Back Pain

Has your back been bothering you for months -- or years -- and still you and your doctor haven't been able to figure out why? You're not alone. Back pain is the most common cause of job-related disability in America, according to the National Institutes of Health, and costs about $50 billion a year in treatments. Some 80% of Americans will experience back pain at some time in their lives. But most cases of back pain can't be traced to a specific, definable cause.

"It's a huge problem that we have for both conventional and alternative techniques for treating back pain," says Daniel C. Cherkin, PhD, a senior investigator at the Group Health Cooperative's Center for Health Studies (CHS) in Seattle. "With this huge category of people who have what's referred to as non-specific back pain, you can't trace it to a particular cause."

This conundrum leads many back pain sufferers to seek out "alternative" treatments -- everything from massage and acupuncture to mind-body therapies and exercise programs like yoga and tai chi. For example, studies show that back pain accounts for 20% of visits to massage therapists and 14% of visits to acupuncturists, Cherkin notes. But do any of these options work?

In many cases, the scientific jury is still out. A recent review of dozens of studies looking at massage, acupuncture, and spinal manipulation (chiropractic) as treatments for low back pain, led by Cherkin, showed some evidence pointing toward the effectiveness of massage and spinal manipulation, but less is known about acupuncture.

"The studies we reviewed found massage to be effective for relieving symptoms and increasing function among people with persistent back pain," Cherkin explains. "Spinal manipulation shows small clinical benefits for back pain -- about the same as conventional medical treatments such as over-the-counter pain relievers and various types of physical therapy."

Based on existing studies, the effectiveness of acupuncture remains unclear, but a new, large study recently launched at the Group Health Cooperative aims to answer some of those questions. To be conducted over four years, the study is recruiting nearly 700 back pain sufferers and will compare acupuncture to conventional care.

Building a Stronger Back
"The most predictable way of resolving back problems, based on the scientific literature, is by increasing strength," says Vert Mooney, MD, director of U.S. Spine and Sport in San Diego. "There's good evidence that with chronic back pain, the muscles around the spine become inhibited, and the most rational treatment is a progressive strengthening program."

Ideally, says Mooney, such a program is best done with calibrated equipment that allows the person with low back pain to gradually increase the amount of strengthening involved so that performance and progress can be measured. "With calisthenic-type exercises, it's very difficult to increase the amount of exercise that you do, so you do enough to stimulate repair but not enough to increase pain," he says.

Florida chiropractor Thomas Hyde, DC, stresses the importance of "core stability" in any exercise program designed to strengthen the back and relieve chronic pain.