Written by Patrick Massey, M.D., Ph.D. More and more evidence shows that combining traditional and nontraditional treatments is best for treating pain.
Chronic back pain has reached epidemic proportions in the United States, costing almost $80 billion a year to treat. After decades of research, we still don’t know what causes it or what works best to treat it, but blending old and new therapies might bring us closer to a real solution.
There are many different ways to treat back pain, with varying success. Physical therapy focuses on weakness and inflammation. Therapists generally use exercise, stretching, ultrasound or electrostimulation and sometimes massage. For chronic back pain, the benefits usually aren’t lasting. Exercise-based therapy, however, might be more successful.
Spinal manipulation is based upon a perceived misalignment of the spine that causes pain. Forceful thrusts are used to bring the spine into alignment. Recent well-designed medical studies have demonstrated that the diagnosis of misalignment is inconsistent and that spinal manipulation is no better than physical therapy, but might be slightly better than medication for lasting relief of chronic back pain.
Orthopedic physicians look for structural damage, often involving discs, the fluid-filled cushions between vertebrae that can bulge or degenerate. However, surgery has never been directly compared with physical therapy, spinal manipulation or even medications for relieving pain. In addition, there is no conclusive evidence that damaged discs are the source of pain. Some physicians suggest that conservative non-surgical treatments are more successful. There are, however, specific indications for surgery, and in those cases the results often are very good.
Medications are about as effective as physical therapy and spinal manipulation. However, benefits are temporary and long-term use might have significant side effects. More than 15,000 people die each year from complications linked to anti-inflammatory medications. Muscle relaxants do not relax muscles; they act more like sedatives. And narcotics have a number of side effects.
Exercise is one of the most beneficial treatments for chronic back pain, medical studies consistently show. There is some suggestion that continuous movement, like tai chi, swimming or dancing might be more beneficial than weight lifting.
Massage therapy consistently has been shown to relieve acute and chronic back pain. I recommend massage by certified massage therapists, who have extensive training and are regulated by the State of Illinois.
Acupuncturists see illness as an “energy flow” problem. Stimulation of specific points in the body promotes the natural healing process. There are a number of good medical studies that demonstrate a benefit and a number of studies that do not. Research from Asia, however, overwhelmingly is positive.
There is good evidence that the effectiveness of any therapy depends on the patient’s belief in the therapy. That might be why mind-body therapies such as meditation and visualization can be as helpful as medications for pain relief.
More and more evidence shows that combining traditional and nontraditional treatments is best for treating pain. For my patients with chronic pain, a program of specific exercise, massage, medications, mind-body therapies and acupuncture can bring lasting pain relief. Sometimes, however, surgery is indicated.
This blending of diverse medical therapies might be our best hope for reversing the epidemic of chronic back pain epidemic.
