Beyond traditional therapies for back pain relief.

Though several treatments for chronic lower back pain--among them NSAIDs, steroid injections, and (in extreme cases) surgery--have often proven effective, for many people keeping the pain under control is still an uphill battle. Outlined here are a few drug-free, noninvasive therapies that patients are turning to in increasing numbers, and with good results.

The E Word

It shouldn't surprise anyone who regularly reads this publication that exercise is among the foremost drug-free therapies for the long-term treatment of lower back pain. The key is to choose a regimen that strengthens both the spine-supporting back muscles and the abdomen, with attention to hip and thigh muscle improvement as well. One study of 346 subjects over six months found an impressive two-thirds pain reduction in patients who targeted these muscle groups. After one year, these patients were taking 34% less pain medication than before. See the website of the American Academy of Orthopedic Surgeons at www.orthoinfo.org, as well as www.nlm.nih.gov/medlineplus/tutorials/backexerciseshp319101.pdf for exercise options for both acute and chronic lower back pain.

While physical therapy and stretching and strengthening exercises that you can perform at home help with acute pain, chronic sufferers may find relief with yoga and Pilates. These routines target the core and stress flexibility, which in turn reduce pressure on the spine. In both cases it's well worth working with a certified instructor, as you need to ensure proper form but also may wish to modify certain positions to better suit your needs. Note that Hatha yoga has an easier pace than Ashtanga or "power" yoga, which is far more intense.

Herbal Therapy

While we're on the subject of remedies with origins in the East, several herbs that have long been associated with back pain relief have exhibited promise in controlled tests. The non-profit research group the Cochrane Library, which systematically reviews clinical trials for a wide spectrum of medical conditions, recently published a review of the following herbal pain remedies: devil's claw, white willow bark, and topical cayenne pepper. All three were repeatedly found to be more effective than placebo, with devil's claw showing the strongest supportive evidence. Notably, most studies did not compare the effectiveness of these remedies to ibuprofen or other common painkillers. Before taking any herbal supplement, ask your doctor to look over the ingredient list, as the makeup and quality of these concoctions vary; some ingredients may not react well with your current medications, if any.

Manipulation

Chiropractic has come a long way from the days when it was largely viewed as unreliable medicine. It is, in fact, one of the world's oldest medical treatments. While studies usually report some improvement with chiropractic treatments, in a review of 39 studies published in 2003, physical therapy and painkillers generally out-performed spinal manipulation. Risk of injury is relatively low, but it is not recommended for people who take blood thinning medication or osteoporosis and arthritis sufferers. Spine stretching, which is not considered part of legitimate chiropractic medicine, has been found to offer little if any relief.

Acupuncture

In traditional Chinese medicine, acupuncture is believed to restore health by promoting the orderly flow of energy throughout the body (chi). The channels of energy are connected by over 2,000 pressure points, where hair-thin needles are inserted at points related to specific organs and bodily systems. Some Western studies suggest that acupuncture works by producing painkilling endorphins. Whatever the mechanism, acupuncture has been repeatedly shown to promote short-term pain relief. In 2005, the Annals of Internal Medicine reviewed 22 randomized, controlled trials specific to acupuncture and lower back pain, and found consistently that it helps reduce short-term pain.

Interestingly, in a 2006 study of 298 patients, 12 sessions over 8 weeks reduced chronic back pain--but those receiving acupuncture outside the traditional pressure points reported similar reductions in pain. Perhaps needle placement is less important than it is believed to be. It's possible the analgesic chemicals theorized to emerge during acupuncture do so regardless of needle placement.

Complementary therapies should not really replace traditional therapies, but there is certainly evidence enough to support trying them. Consult your doctor to determine which might be best for you.

(Health After 50, the Johns Hopkins Medical Newsletter, 2006, Vol. 18, No. 8, pp. 3-7; www.medicalacupuncture.org; www.orthoinfo.org; www.acatoday.com; www.nlm.nih.gov)