Low Back Pain: Many Options for Relief
Expert Panel Says a Variety of Treatments Can Ease Pain Without Surgery
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
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.
Back Pain Relief Menu
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
- Intensive interdisciplinary rehabilitation (physical, vocational, and
behavioral therapies provided by multiple providers with different clinical
- Massage therapy
- 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."