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Low Back Pain: Many Options for Relief

Expert Panel Says a Variety of Treatments Can Ease Pain Without Surgery
By
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 1, 2007 -- People who suffer low back pain have high odds of finding relief without surgery, an expert panel says.

The panel, made up of experts from the American Pain Society and the American College of Physicians, has released guidelines for the diagnosis and treatment of low back pain.

The guidelines cover what doctors call "nonspecific low back pain" -- that is, back pain not due to a specific condition such as cancer, a slipped disk, a compressed nerve, or a fracture.

If you have this kind of bad pain, there's good news, says panelist Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland. Chou is director of the clinical guidelines development program of the American Pain Society.

"There are lots of options out there that have pretty good evidence they work," Chou tells WebMD. "There is no one perfect treatment for everybody. If you are interested in spinal manipulation and acupuncture, the evidence is just as good as for medications."

Once upon a time, doctors told people with low back pain to stay in bed for three days -- perhaps with a board under their mattress. That very bad advice actually made back pain worse, Chou says.

"We don't want people lying in bed," he says. "Get out. Try a normal range of activities, but back off if your back hurts. But you won't hurt your back by doing regular stuff, and it may actually keep your back conditioned and strong."

Doctors also used to give routine X-rays to patients complaining of low back pain. That, according to the expert panel, also is wrong. X-rays are indicated only when a doctor has reason to suspect an underlying condition that could be confirmed by imaging studies.

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Most people with low back pain have an acute pain episode. But up to a third of patients report persistent pain of at least moderate intensity -- chronic low back pain.

The panel found evidence that different patients can get relief from a wide variety of treatments. These treatments include:

  • Cognitive-behavioral psychotherapy
  • Exercise therapy
  • Spinal manipulation from a chiropractor, osteopath, or physical therapist
  • Intensive interdisciplinary rehabilitation (physical, vocational, and behavioral therapies provided by multiple providers with different clinical backgrounds)
  • Acupuncture
  • Massage therapy
  • Yoga
  • Progressive relaxation

"Patients and doctors need to talk," Chou says. "Don't use stuff not backed up by evidence. Don't fall for stuff just because it's touted on the Internet or whatever."

Scott D. Boden, MD, professor of orthopaedic surgery and director of the Emory University orthopaedics and spine center, says the panel's advice confirms what back specialists have been saying for years.

"These programs have been around for 15 to 20 years," Boden tells WebMD. "Some studies show they have a benefit, some not. A lot of this has to do with the psychological makeup of patients."

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