John 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.
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
hurt:
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 what doesn't Patients with low back pain who present
with so-called "red flag" may be at risk of
serious disease and require further medical evaluation and treatment.
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 therapy. Conventional medicine
also appears to have little to offer in the treatment of chronic
low back pain besides muscle relaxants, anti-inflammatory medicine
(NSAIDs), 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.
Alternative 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,
1999).
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). For urther reading on drugs
Vs. chiropractic read Choose
Chiropractic Before Pills for Low Back Pain.
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, 1999).
Conclusion
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 be required.
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.
This article was updated on 15 Aug. 2000.
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