Brunilda Nazario, MD
From acupuncture to yoga, many different alternative treatments purport to relieve chronic back pain. Which are worth trying?
“As long as you’ve had your back pain problem checked out by a doctor to rule out a serious disease, it would be reasonable to try any of a number of alternative treatments,” says Daniel C. Cherkin, PhD, a senior investigator at Group Health Research Institute in Seattle who has conducted research on alternative medical techniques for back pain.
Of course, experts say it’s best to stick with the alternative treatments that are proven to be safe and potentially effective. Here are seven:
Acupuncture. Can inserting needles in your body really relieve lower back pain? Recent studies, including a randomized trial of acupuncture published in the Archives of Internal Medicine, suggest that it may. The only question seems to be why this ancient healing tradition works.
Practitioners of traditional Chinese medicine maintain that the needles affect the flow of a “vital energy” known as qi (pronounced chee) within the body. Some scientists suggest that it works by triggering the release of natural painkillers known as endorphins.
Donald B. Levy, MD, medical director of Brigham and Women’s Hospital’s Osher Clinical Center for Complementary and Integrative Medical Therapies in Chestnut Hill, Mass., says that how acupuncture works may not matter, at least from the patient’s perspective. “I can’t explain how my car works,” says Levy, who is also an assistant clinical professor of medicine at Harvard Medical School in Boston. “I just know that if I turn the key properly in the ignition, it starts.”
Acupuncture needles typically stay in place for 20 to 30 minutes, and several sessions may be required.
Alexander technique. This type of physical therapy uses hands-on training to teach people to avoid specific postures and ways of moving that cause pain by placing undue strain on the musculoskeletal system. It pays particular attention to releasing tension in the neck, back, and spine. Its name comes from an Australian actor named F. M. Alexander, who developed the technique.
There isn't a lot of research on the Alexander technique, but one study published in the journal BMJ showed that people given one-on-one training in the technique reduced their back pain. "This is an effective technique to improve pain and function in the long term," one of the study's authors, Paul Little, PhD, professor of primary care research at the University of Southampton in England, told WebMD in an email. But "it's not a magic bullet. It requires time and application."
Biofeedback. This high-tech treatment can help you learn to loosen tight muscles by using your mind to control your body. To learn biofeedback, sensors are applied to your body that give continuous feedback about body functions such as heart rate, breathing, blood pressure, muscle tension, and brain wave activity. A biofeedback therapist teaches you relaxation techniques so you can see how to control a specific body function. As you become aware of the connection between the mind and the body, you may be able to reduce muscle tension and relieve pain.
Although there’s no compelling evidence to show that biofeedback works specifically for chronic back pain, there is evidence that it can ease chronic pain generally. It’s worth a try, Cherkin says.
Chiropractic. Chiropractic’s signature treatment, spinal manipulation, may help relieve back pain. The National Center for Complementary and Alternative Medicine reports that spinal manipulation “appears to be as effective as conventional treatments.”
“We don’t know what’s going on in the body [during spinal manipulation],” says William C. Meeker, DC, president of Palmer College of Chiropractic in San Jose, Calif. “But we know that it alleviates sensations of pain and soreness and increases joint mobility.”
During your first visit, the chiropractor will usually take a medical history and do a physical exam that focuses closely on the spine. In subsequent visits, the chiropractor will use twisting, pulling, or pushing movements to adjust the bones and joints in your spine. The chiropractor may also use heat, electrical stimulation, or ultrasound to relax your muscles.
Physical therapists, osteopaths, and even some conventional medical doctors use spinal manipulation, too. Health insurance plans often cover the cost of chiropractic care.
Massage. It feels good to get a massage, and massage does ease the muscle tension that often accompanies back pain. Though few studies have looked at massage as a remedy for chronic back pain, Cherkin says all showed positive results. Cherkin's own study, the largest of its kind, showed that back pain sufferers treated with 10 weekly massage visits got long-lasting pain relief.
Meditation. A kind of meditation known as mindfulness may help ease chronic back pain, possibly by changing emotions that tend to make pain worse. “The emotional component of pain cannot be overestimated,” says Natalia E. Morone, MD, assistant professor of medicine at the University of Pittsburgh School of Medicine.
“Mindfulness helps people become aware of thoughts, emotions, and sensations without judging them,” Morone says. She says that the overall pain-relieving effect of mindfulness appears small, though some people who participated in her studies experienced dramatic pain relief. Others said that, although they continued to have back pain, it didn’t bother them as much.
Yoga. For anyone with a bad back, learning yoga might sound like the ultimate bad dream. Why would anyone wracked with pain want to try poses (asanas) with names like "Cobra Posture" and "Supine Butterfly?" But research suggests that this ancient movement-and-meditation technique can ease chronic back pain. In one study, people with back pain who took 12 classes learning a gentle, easy-to-do form of yoga known as viniyoga had pain relief that lasted at least several months.
"Yoga was clearly better than self-care," says one of the study’s authors, Karen J. Sherman, PhD, senior investigator at Group Health Research Institute. "It's certainly worth trying, but only if you're willing to practice." She recommends finding a yoga instructor who has experience working with people who have back pain, and cautions that physically demanding forms of yoga could actually make back pain worse.
SOURCES:American Chiropractic Association: “Back Pain Facts & Statistics.”American Society for the Alexander Technique: “What Is the Alexander Technique?”Association for Applied Psychophysiology and Biofeedback: “About Biofeedback.”Daniel C. Cherkin, PhD, senior investigator, Group Health Research Institute, Seattle.Cherkin, D. Archives of Alternative Medicine. March 11, 2009; vol 169; pp 858-866.Cherkin, D. Archives of Internal Medicine. April 23, 2001; vol 161; pp 1081-1088.Donald B. Levy, MD, medical director, Osher Clinical Center for Complementary and Integrative Medical Therapies, Chestnut Hill, Massachusetts, and assistant clinical professor of medicine, Harvard Medical School, Boston.Paul Little, PhD, professor of primary care research, University of Southampton, England.Little, P. British Medical Journal. Aug. 19, 2008; vol 337: pp 1-8 [BMJ online first]William C. Meeker, DC, president, Palmer College of Chiropractic, San Jose, California.Natalia E. Morone, MD, assistant professor of medicine, University of Pittsburgh School of Medicine.Morone, N. Pain. February 2008; vol 134; pp 310-319.National Center for Complementary and Alternative Medicine: “Spinal Manipulation for Low-Back Pain.”National Center for Complementary and Alternative Medicine: “Acupuncture: An Introduction.”Karen J. Sherman, PhD, senior investigator, Group Health Research Institute, Seattle.Sherman, K. Annals of Internal Medicine. Dec. 20, 2005; vol 143: pp 849-856.http://www.annals.org/content/143/12/849.full
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