Chronic back pain: Osher Center's clinical update on Complementary and Alternative Medicine treatments

Finding movement

Photo: © Rosalie O'Connor 2005-2007. All Rights Reserved. Reprinted with permission, courtesy of FGNA.

July 3, 2008 - 7:45am -- Rob Black
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Publication Type:

Magazine Article




United States (2004)



<p>Back pain ranks as the second most common reason for visiting the doctor's office (1). In fact, more than 70% of the population suffers from back pain at some point with an annual incidence of 15% (1). Conventional medicine offers treatment options that typically include analgesics, physical therapy, exercise and &quot;back school&quot; education programs. In severe cases, patients may also seek surgery or the services of a pain management center.</p> <p>Despite this range of interventions, large numbers of patients turn to complementary/alternative medicine (CAM) treatments for back pain (2,3). These can include spinal manipulation, acupuncture, massage, yoga and stress reduction programs.</p> <p>Here is a brief overview of some of the most common CAM practices and what is known about their efficacy in the treatment of chronic back pain.</p>


<p>Jacobs, Bradly (2004). Chronic back pain. <em>Nautilus</em>, Osher Center's clinical update on complementary and alternative medicine treatments.</p><p>Published online: </p><p>Some quotes:</p> <p>... Many other practices, such as Pilates or Feldenkrais, are used by people with back pain, although they have not been well studied. Pilates is a systematic practice of gentle exercises coupled with focused breathing, often designed to improve flexibility and core body strength. Feldenkrais is an educational system that helps patients improve physical functioning through gentle movements. It teaches awareness of habitual neuromuscular patterns and identifies ways to expand options for moving with increased sensitivity and efficiency. Although their efficacy has not been documented, these practices are quite safe when taught under the direction of an experienced, certified instructor.</p> <p>... The following table highlights research on the safety and efficacy of selected CAM treatments for chronic back pain. Please note that this table does NOT address safety and efficacy for neck pain. </p> <strong>Chronic Back Pain: Highlights of research on CAM treatments</strong> <p class="subheader">Modality</p> <p class="subheader">Evidence</p> <p class="subheader">Safety</p> &nbsp; <p class="smalltext">Massage</p> <p class="smalltext">B</p> <p class="smalltext">1</p> &nbsp; <p class="smalltext">Acupuncture</p> <p class="smalltext">D</p> <p class="smalltext">1</p> &nbsp; <p class="smalltext">Spinal Manipulation</p> <p class="smalltext">C</p> <p class="smalltext">1</p> &nbsp; <p class="smalltext">Yoga</p> <p class="smalltext">B</p> <p class="SMALLTEXT">2</p> &nbsp; <p class="smalltext">Herbs and Dietary Supplements</p> <p class="smalltext">D</p> <p class="SMALLTEXT">3</p> &nbsp; <p class="smalltext">MBSR</p> <p class="smalltext">C</p> <p class="smalltext">1</p> &nbsp; <p class="smalltext">Pilates</p> <p class="smalltext">D</p> <p class="SMALLTEXT">3</p> &nbsp; <p class="smalltext">Feldenkrais</p> <p class="SMALLTEXT">D</p> <p class="smalltext">2</p> &nbsp; <p class="smalltext">Exercise</p> <p class="SMALLTEXT">A</p> <p class="smalltext">1</p> &nbsp; <p class="smalltext">Tai Chi</p> <p class="smalltext">D</p> <p class="smalltext">3</p> &nbsp; <p class="smalltext">Breath Therapy</p> <p class="smalltext">D</p> <p class="smalltext">2</p> &nbsp; <p class="smalltext">Qi Gong</p> <p class="smalltext">D</p> <p class="SMALLTEXT">3</p> &nbsp; Back Schools A 1 &nbsp; <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> &nbsp; &nbsp; Evidence A multiple large randomized controlled trials (RCTs), systematic review, or meta-analysis showing efficacy B few small RCTs showing efficacy C 1 small RCT or multiple non-RCT trials showing efficacy D insufficient data, contradictory findings E data showing lack of evidence or benefit &nbsp; &nbsp; Safety (when properly performed by experienced practitioners) 1 clearly safe 2 likely safe 3 unknown 4 may cause harm