Pursuing a pill-free approach to back pain

From exercise to meditation, a U.S. report examines nine options, write

Three months ago, Bruce threw his back out while bending over to help his grandson tie his skates. Although he has had occasional back trouble in the past, this flare-up was different and simply did not want to go away.

The pain was constant, deep and worsened when walking or making sudden movements. It was starting to interfere with his everyday life, preventing him from gardening, driving for long periods and even feeling present at family gatherings. He was starting to feel helpless and frustrated at the lack of improvement.

Pain medication prescribed by his doctor helped initially but was now making him feel dopey and causing an upset stomach.

Having recently been introduced to Dr. Google by the same grandson, he asked the search engine about possible alternatives to medication for improving ongoing lower back pain. What he found was overwhelming; there seemed to be endless non-medicinal options for treating low back pain, including yoga, acupuncture, spinal manipulation, exercise, massage, tai chi and even meditation. Desperate for something to alleviate the pain and get him back to normal activities, he felt somewhat lost trying to decide what he should do next.

Low back pain is an extremely common condition and is experienced by most people at some point in their lives. In fact, low back pain causes more disability than any other condition worldwide leading to lost work days and in some cases depression. Studies have shown that low back pain becomes gradually more common with age until one reaches the 60-65 age group, when it begins to decline.

There are generally two categories of low back pain; acute and chronic. Though both can be extremely painful, acute low back pain is usually thought of as lasting for four weeks or less, and is typically associated with sharper pain. Chronic low back pain, which can develop after acute back pain, is often more gradual and is defined as lasting for at least three months. Often, this type of pain even travels down the legs, as nerves coming from the spine are irritated, causing what is known as radicular pain.

When low back pain hits, most people reach for medication. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are effective in relieving low back pain. Unfortunately, they can also cause side-effects, especially if taken in higher doses for long periods of time. These include stomach upset, high blood pressure, ulcers and kidney damage. Muscle relaxants are another common type of drug taken to treat low back pain. Though these can also be effective, common side-effects are drowsiness and dry mouth. Stronger, prescribed medications such as codeine or oxycodone will also alleviate low back pain. However, there are risks associated with these medications, among the most serious being addiction.

Lesser-known, non-drug options include mindfulnessbased stress reduction, which is a form of meditation. Multidisciplinary rehabilitation addressed both the physical and mental aspects of back pain by having a team of healthcare professionals, including physiotherapists and psychologists to help treat pain and improve function. Psychological therapies such as progressive muscle relaxation have also been presented as an option, and aim to improve body awareness and relaxation.

How can one possibly sort through all these pill-free options? The answer can be found in a report commissioned by the American College of Physicians and carried out by the U.S. Agency for Healthcare Research and Quality, a branch of the federal government. The research team that put the report together looked at the most reliable research related to nine non-pharmacologic treatments for low back pain, many already mentioned here.

They identified and combined 114 research studies that tested one of these treatments against non-treatment although in some cases, like acupuncture, the comparison group received something that was convincingly similar to the real thing so as to eliminate a placebo effect. The researchers were able to report on how well the treatment worked for reducing pain and returning back pain sufferers to normal function. Benefits were reported as small, moderate and large or no improvement seen. They also weighed in on the reliability of the studies.

Exercise treatments were the most well-studied option and showed a small benefit for both pain relief and return of function. A specific type of physical activity known as motor control exercise showed a stronger effect. Among old world treatments, yoga, tai chi and acupuncture had generally small benefits although acupuncture had a more pronounced effect on pain relief than function.

The meditation-based treatments like mindfulness delivered only small improvements while the strongest improvements came as a result of working with multidisciplinary rehabilitation teams.

The most disappointing results appear to come from massage and spinal manipulation with the best studies suggesting no improvement. None of the nopill approaches demonstrated a strong effect or any harm.

While the research findings noted here may help direct back pain sufferers to a first option, a best fit for any individual is often a decision that should be made in consultation with your physician.