Exercise, Tai chi, Yoga, Acupuncture More Effective for Back Pain
New guidelines for low back pain released by the American College of Physicians (ACP) reveal a significant turnaround in terms of medical doctors accepting alternative therapies. For years, the ACP guidelines have guided doctors and patients towards addictive opiod pain-killers and aggressive surgeries that often don’t work.
Why the turnaround? Because the evidence is simply not there for the conventional therapies. Conventional therapies simply do not work much of the time. And they have left millions of low-back pain patients addicted to opiod drugs or living with metal bars in their spines – robbing them of mobility for the rest of their lives.
Two important changes
The ACP last published their clinical practice guidelines for low back pain in 2007. There have been two changes since then. In 2010, the ACP changed its criteria regarding evidence-based guidelines. These had to eliminate conflicts of interest and carefully examine the evidence.
But the big change is the avalanche of research over the past years proving out alternative treatments for low back pain.
Yes, the new guidelines, published in the Annals of Internal Medicine journal, examined this new clinical evidence. And there is a lot of evidence – covering hundreds of studies on thousands of low back pain patients.
For their latest recommendations, the ACP researchers conducted a thorough review of the various therapies for low-back pain. Here is what they found:
The researchers found 122 studies that tested exercise for low-back pain. For chronic low back pain, they found that exercise resulted in significant improvement of mobility and reduction of pain compared to no exercise. Also, exercise typically beat conventional therapies for treating low back pain.
The researchers found that exercise resulted in reduced pain intensity in a number of studies. They also found that exercise reduced work disability.
The researchers also found that exercise reduced radicular low back pain better than no exercise or conventional therapies. Radicular low-back pain means pain related to spinal nerve root damage.
Motor controlled exercise also resulted in greater reductions of pain and better mobility. This worked for short-term as well as longer-term low back pain. Motor controlled exercise relates to exercising the trunk and abdomen regions in a systematic way.
The researchers found 14 clinical studies on hatha-yoga and chronic low back pain. These included over 1,400 low back pain patients. The studies found yoga reduced pain slightly better than exercise, and significantly better than no yoga exercise.
Reduced pain intensity was also found and better long-term mobility was achieved with longer-term yoga exercises in many of the studies.
The researchers found two acceptable clinical studies – on 480 low back pain patients. These found that tai chi reduced pain greater than no tai chi and no treatment.
The researchers analyzed 49 clinical trials on acupuncture for low-back pain. The researchers found that acupuncture decreased pain intensity. Acupuncture was typically better than treatments with NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxers or analgesic drugs. The difference in pain reduction was close to 11 percent compared to these conventional treatments.
Acupuncture was also successful in reducing chronic low back pain. It increased mobility and function as well in many studies.
The researchers analyzed 26 clinical trials that tested massage for low back pain. These included Swedish massage, soft tissue release, foot reflexology and stretching. The research found that massage often reduced pain at or greater than conventional care. In 8 of 9 studies, massage beat other noninvasive interventions such as spinal manipulation, exercise, relaxation therapy, acupuncture, physiotherapy and transcutaneous electrical nerve stimulation in terms of pain reduction. The differences ranged from 0.6 to 0.9 points on a 10-point scale.
Other studies found that massage reduced chronic low back pain slightly better than conventional therapy.
We discussed massage for low back pain in this article.
Mindfulness stress reduction
The researchers found three mindfulness studies on more than 650 low-back pain patients. The research found that mindfulness reduced pain more than conventional therapy (by 1.4 out of 10 scale). They found mindfulness increased the likelihood of achieving more than 30 percent pain reduction.
Other relaxation therapies
The researchers also found 32 studies on other relaxation therapies. They found that progressive relaxation reduced pain by nearly 20%. Biofeedback (electromyography) also reduced pain. So did cognitive behavioral therapy.
Rehabilitation was studied in 44 clinical trials. The researchers found these confirmed that rehab reduced pain intensity on a short-term and long-term basis better than conventional therapy and no therapy. The differences in pain intensity ranged from 1.4 to 1.7 out of a 10-point pain scale.
This is what many chiropractors do for low back pain. The researchers found 61 clinical studies on spinal manipulation and low back pain. Their analysis found small reductions in pain after one month of treatment. But in studies that followed patients for six months and/or one year, they generally found no significant reduction in pain from spinal manipulation therapy.
A larger trial on radicular pain showed manipulation decreased pain. But this also included home exercise.
“Manipulation resulted in greater improvement in function than other active interventions at 1 month; the effects were smaller and no longer statistically significant at 6 and 12 months.”
Do no harm
The research proves that treatments which induce as little harm as possible are the most successful. Treatments that harm the most include surgery and drugs such as opiods, steroids, relaxants and NSAIDs.
The researchers noted:
“Some evidence supports the effectiveness of several nonpharmacologic therapies for chronic low back pain, and limited evidence shows that acupuncture is effective for acute low back pain.”
The term, “nonpharmacologic” simply means non-drug therapies.
In addition to finding good results for non-drug therapies, the researchers also found evidence that acetaminophen does not reduce low back pain compared to placebo. The research also found that systemic steroids to be ineffective for treating low back pain.
The researchers recommended that chronic low back pain patients are first treated with exercise and other non-drug therapies. These include yoga, tai chi, rehabilitation, acupuncture and mindfulness therapies.
Dr. Nitin S. Damle, president of the ACP, commented on the research:
“Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.”
Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. Epub ahead of print 14 February 2017. doi: 10.7326/M16-2459
Qaseem A, Snow V, Owens DK, Shekelle P, Clinical Guidelines Committee of the American College of Physicians. The Development of Clinical Practice Guidelines. Ann Intern Med. 2010;153:194-199. doi: 10.7326/0003-4819-153-3-201008030-00010