Low-Back Pain and Complementary Health Approaches: What You Need To Know

There are many treatment options for low back pain, from stretching and exercise to meditation and Tai Chi. Shutterstock

What’s the Bottom Line?

What do we know about the effectiveness of complementary health approaches for low-back pain?

• There’s low- or moderate-quality evidence that a variety of mind and body practices, including acupuncture, electromyography biofeedback, low-level laser therapy, mindfulness-based stress reduction, progressive muscle relaxation, spinal manipulation, tai chi, and yoga, may be helpful for chronic low-back pain.
• There’s low-quality evidence that acupuncture, massage therapy, and spinal manipulation may be helpful for acute low-back pain.
• Preparations of the herb cayenne, used topically, may help to relieve low-back pain.

What do we know about the safety of complementary health approaches for low-back pain?

• The mind and body practices mentioned above (acupuncture, electromyography biofeedback, low-level laser therapy, massage therapy, mindfulness-based stress reduction, progressive muscle relaxation, spinal manipulation, tai chi, and yoga) have good safety records when used appropriately. However, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches.
• If you’re considering natural products such as oral or topical herbal products, remember that natural doesn’t always mean safe and that some natural products may have side effects or interact with medications.

Some Basics About Low-Back Pain

Low-back pain is a very common problem in the United States and around the world. About 80 percent of adults have low-back pain at some point in their lives. It’s the most common cause of job-related disability and a leading contributor to missed work days and visits to physicians.

Most episodes of low-back pain last only a short period of time. Health professionals call this acute low-back pain. Acute low-back pain is often defined as pain that lasts for up to 4 weeks. In most cases, acute low-back pain goes away without causing any lasting problems.

Low-back pain that lasts for between 4 and 12 weeks is called subacute.

If low-back pain lasts for 12 weeks or longer, it’s called chronic. Treatment sometimes relieves chronic low-back pain successfully, but in other cases, pain persists despite treatment.

Clinical Practice Guidelines for Treating Low-Back Pain

Clinical practice guidelines provide recommendations, developed by groups of experts, to help health care providers and patients make informed decisions about what types of care to use. They’re based on reviews of the scientific evidence and assessments of the potential benefits and harms of different care options. The guidelines are updated frequently as new evidence becomes available.

The American College of Physicians issued a clinical practice guideline for the treatment of low-back pain in 2017. The guideline recommends that health care providers and patients use nondrug treatments as first-line therapy for chronic low-back pain. It also recommends the use of nondrug approaches for acute low-back pain, with or without drug therapy. Several complementary health approaches are among the treatment options suggested for acute low-back pain, chronic low-back pain, or both.

What the Science Says About Complementary Health Approaches for Low-Back Pain

Mind and Body Approaches:

Acupuncture

• Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin.
• A 2017 evaluation of 49 studies of acupuncture for low-back pain with more than 7,900 participants found evidence that acupuncture has a modest benefit on acute low-back pain and a moderate benefit on chronic low-back pain.
• A 2018 review by the Agency for Healthcare Research and Quality (AHRQ) looked at the impact of therapies for chronic low-back pain at least 1 month after the end of treatment. It found that acupuncture was associated with slightly greater effects on pain and function at 1-6 months when compared to controls, such as sham (simulated) acupuncture or usual care. One study also found a greater reduction in pain after more than 12 months.
• The American College of Physicians clinical practice guideline on low-back pain treatment includes acupuncture as an option for initial treatment of chronic low-back pain (based on moderate-quality evidence) and as a treatment option for acute/subacute low-back pain (based on low-quality evidence).
• Serious complications of acupuncture are rare.

Massage Therapy

• Massage therapy involves manipulating the soft tissues of the body with the goal of helping to manage a health condition or enhance wellness.
• A 2015 review of 25 studies of massage for low-back pain, with about 3,000 participants, found that it may produce short-term improvements in pain. The quality of the evidence was low to very low.
• A 2018 AHRQ review that looked at the impact of therapies for chronic low-back pain at least 1 month after the end of treatment found that massage therapy was associated with slightly greater effects on pain and function after 1-6 months, compared to sham (simulated) massage or usual care. There was no evidence of an effect at 6-12 months.
• The American College of Physicians clinical practice guideline for low-back pain treatment includes massage as a treatment option for acute/subacute low-back pain (based on low-quality evidence). It does not recommend massage therapy as an option for chronic low-back pain.
• The risk of harmful effects from massage therapy appears to be low.

Mindfulness-Based Stress Reduction

• The term “mindfulness” can refer to a variety of practices, but most definitions involve keeping attention or awareness on the experience of the present moment and being open or accepting toward that experience. Mindfulness-based stress reduction (MBSR) is a structured program that teaches meditation and mindfulness, including incorporation of mindfulness into everyday life.
• A 2017 review of 7 studies (864 participants) that evaluated MBSR for low-back pain found evidence of short-term improvements in pain intensity and physical functioning, but it was uncertain whether the improvement was large enough to be meaningful to patients.
• A 2018 AHRQ review that looked at the impact of therapies at least 1 month after the end of treatment found that MBSR was associated with slightly greater effects on pain after 1-6 and 6-12 months, when compared to usual care. There was no evidence of an impact on function.
• The American College of Physicians clinical practice guideline for low-back pain treatment includes MBSR as an option for initial treatment of chronic low-back pain (based on moderate-quality evidence).
• Mindfulness-based interventions are usually considered safe for most people. However, because only a few studies have systematically looked in detail for harmful effects, it isn’t possible to make definite statements about their safety.

Tai Chi

• Tai chi is a centuries-old mind and body practice that combines certain postures and gentle movements with mental focus, breathing, and relaxation.
• A 2016 review of 3 studies of tai chi for low-back pain (385 participants), all of which involved at least 10 weeks of tai chi, found it was helpful. In two additional studies, not included in the review, tai chi was at least as helpful as some other treatments for low-back pain and better than no treatment.
• The American College of Physicians clinical practice guideline for low-back pain treatment includes tai chi as an option for initial treatment of chronic low-back pain (based on low-quality evidence).
• Tai chi is generally considered safe. It may lead to minor aches and pains but is unlikely to cause serious injury.