Complementary, supplemental and physical therapies for back pain
Introduction
Low back pain is a common, awkward and limiting health problem. Non-specific low back pain describes pain that has no identifiable cause. Most people will recover rapidly regardless of what therapy they have.
Possible causes of back pain include a nerve (radicular) syndrome, inflammation, infection, osteoporosis, rheumatoid arthritis, fracture, or cancer.
The aim of treatment is to reduce the pain and improve mobility. Drug therapy alone is often not effective and may cause adverse effects, such as stomach upsets with non-steroidal anti-inflammatory drugs (NSAIDs), and kidney problems with persistent high use of conventional painkillers (paracetamol and codeine).
| Healthcare condition | Intervention | About the findings |
|---|---|---|
| Back pain | Massage for lower back pain | 13 trials |
| TENS | 4 trials |
We present some of the evidence from Cochrane systematic reviews about complementary and alternative treatments related to back pain. This evidence comes from carefully researched reviews of information about clinical trials done to evaluate medical treatments. Studies are only included in these reviews if they meet pre-defined criteria.
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Massage for lower back pain
Massage is the kneading and rubbing of muscles and joints, usually with the hands, to relieve body tension and pain and increase the blood circulation.
Acupressure is a form of massage that involves pressing down on acupuncture points.
What the synthesised research says
Massage may help people with persistent or long lasting (chronic) non-specific low back pain, particularly when they also receive some education and exercises.
Two controlled studies compared massage to a sham treatment (control) and found that massage was clearly more effective at reducing pain and improving function in both the short and long term. Pain was reduced by some 40%. After one month, 63% of participants in the massage group reported no pain, whereas everyone in the control group still had pain.
Eight controlled trials compared massage to an active treatment. Massage was as effective as exercises; and better than joint mobilisation, relaxation therapy, physical therapy, acupuncture, self-care education and foot reflexology (which had no benefit).
Two studies compared different types of massage. One found that acupressure massage was better than classical Swedish massage and the other found that Thai and classical massage were equally effective.
The beneficial effects of massage in patients with chronic low back pain lasted for at least one year after the end of treatment.
How it was tested
The researchers searched the medical literature thoroughly and found 13 trials involving a total of 1596 participants. Eight of the trials were considered to have important design faults.
Different massage techniques, duration and frequency of treatments were used in the studies. The most significant benefits were observed in the studies that used a trained massage therapist with many years of experience or a licensed massage therapist.
One study found that the number of healthcare provider visits, pain medication and outpatient back-care services were 40% lower in the massage group.
Side effects and general cautions
Massage is generally accepted as safe, although some people may experience minor pain or discomfort during or after the massage. Some people develop an allergic reaction to massage oil, which appears as a rash or pimples. Important contraindications to massage include applying massage over an inflamed area, skin infection, burn area, deep vein thrombosis a fracture that has not healed, or over sites of active cancer tumour.
Source
Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.pub2.
TENS for lower back pain
What is known
A TENS unit consists of a hand-held device connected to electrodes which are attached to the skin. The electrodes are usually placed on the painful area or corresponding to the nerve pathways through which painful impulses travel to the spinal cord. The TENS unit gives out low voltage impulses, the frequency and intensity of which can be controlled by the person using the device. The person experiences a tingling or buzzing feeling at the site of the electrodes. At low voltages these sensations are not painful. TENS can also be used to stimulate acupuncture points.
TENS therapy is used to treat a variety of painful conditions, both sudden in onset (acute) and longer-term or chronic, and is generally used with other painkillers (analgesics).
What the synthesised research says
The use of TENS to manage chronic low back pain is not supported by high quality controlled clinical studies because of the variability of the findings of the different trials.
The intervention involved daily treatment with TENS for between 20 minutes and 3 hours over 3 to 4 weeks.
How it was tested
The researchers made a thorough search of the literature and found 4 controlled trials that randomly assigned a total of 585 participants to receive TENS or not.
One small trial (60 participants) found a clear benefit with TENS but two others (410 participants) reported that TENS had no effect on the level of disability due to back pain.
Similarly, one trial (60 participants) reported reduced pain with TENS but two trials (175 participants) found no difference in pain reduction at two and four weeks. Days off work and the use of medical services did not appear to change with treatment.
In general, patients treated with acupuncture-like TENS (electrodes places over acupuncture points) responded similarly to those treated with conventional TENS. However, in two of the trials inadequate stimulation intensity was used for the acupuncture-like TENS.
Side effects and general cautions
Only one trial reported adverse effects. Although a third of participants experienced minor skin irritation at the site of the electrodes, this was no different with active TENS or sham (pretend) TENS.
Source
Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003008. DOI: 10.1002/14651858.CD003008.pub3.
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