Studies have reported that more than half of people who consulted a medical doctor for back pain had tried some sort of therapy outside the realm of conventional, mainstream Western medicine. Some of these options are among those recommended by the American College of Physicians (ACP) treatment guidelines. When contemplating one of these therapies, however, it’s important to remember that the treatments are considered alternative precisely because there is not enough scientific evidence to prove that they work consistently. Many may work primarily, or solely, via a placebo effect, which is suggested by studies finding that sham versions work as well as the real treatments.
You should be particularly cautious about undertaking any treatments that are expensive and require more than half a dozen visits. And if you are using any type of alternative therapy, be sure to inform your doctor.
- Acupuncture. This treatment is based on the traditional Chinese medical theory that pain and disease occur when the body’s natural energies (chi) are out of balance. Stimulating points where chi pathways (meridians) intersect using acupuncture needles is meant to correct the improper flow. Acupuncture may relieve pain by triggering nerves to send out natural, pain-blocking chemicals (endorphins). Acupuncture is one of the few alternative therapies covered by many insurance companies.
- Acupressure. Like acupuncture, acupressure is based on the traditional Chinese medical theory of energy channels in the body. Instead of inserting needles, continuous pressure is exerted on a meridian intersection for three to five minutes. Relief of pain from acupressure is thought to be shorter-lasting than that of acupuncture.
- Massage therapy. Massage can help temporarily by relaxing muscles and easing tension in the back.
- Spinal manipulation. Chiropractors, osteopaths, and physical therapists may provide spinal manipulation of the low back. There’s reasonable evidence that this therapy is as modestly effective as a number of other standard therapies, though it is unclear how much better it works than a placebo. Manipulation of a spine that is weakened by osteoporosis or cancer could result in further, more serious injury.
- Tai chi. Originally a Chinese martial art, this ancient practice involves slow, balanced, low-impact movements. The ACP guidelines note that some studies have shown that tai chi improves pain and function in people with back pain.
- TENS. Transcutaneous electrical nerve stimulation, or TENS, delivers pulsed electricity through electrodes attached to the skin via adhesive pads. TENS may interfere with the transmission of pain signals via nerve fibers of the spinal cord or affect neurotransmitters that mediate pain. For chronic low back pain, a Cochrane review of four studies concluded that the evidence was conflicting, and thus the efficacy of TENS was unclear.
- Yoga. A 2017 Cochrane review concluded that there is low to moderate evidence that yoga, compared to non-exercise controls, results in small to moderate improvements in back-related function at three and six months. There are many types of yoga. If a serious condition, such as a herniated disc, scoliosis, spinal stenosis, spondylolisthesis, or a vertebral compression fracture is responsible for back pain, however, certain yoga poses may worsen the condition.
This article first appeared in the UC Berkeley Wellness Letter.