Low back pain is one of the most common health conditions today. According to some estimates, each year nearly 15% to 20% of the United States population experiences low back problems, and as many as 80% of all adults experience significant low back pain at some point during their lives.1,2 Back pain is the second most common reason adults under age 45 miss days from work (after the common cold). The total cost of back pain has been estimated to reach $25 billion per year in the US.3
When back pain occurs suddenly (after lifting a heavy object, for example), it is called acute back pain or sprain. In most cases, acute back pain eventually improves by itself, but there may be weeks of discomfort, time lost from work, and impaired function at home.
When back pain persists over months or years, it is called chronic back pain. In the majority of cases, the cause of chronic back pain is unknown. Identifiable causes include osteoarthritis, fracture, or injury to the discs between the vertebrae.
Conventional treatment of acute back pain involves anti-inflammatory drugs, muscle relaxants, and the passage of time. Chronic back pain requires a medical workup to make sure there are no serious underlying causes, although evidence suggests that, in most cases, x-rays are not necessary.4 Treatment may also include physical therapy and a graded exercise program, which includes walking. However, there is little reliable evidence that these treatments actually provide much benefit.64,65,94-97 Surgery may be recommended in certain cases, such as when there are severe disc problems, but most forms of back surgery also lack reliable supporting evidence.
Principal Proposed Natural Treatments
Extract of the herb white willow appears to be helpful for acute and chronic back pain, presumably because of its similarity to aspirin. The little-known injection technique known as prolotherapy may be effective for back pain as well. Lesser evidence supports the use of chiropractic and acupuncture.
Willow bark has been used as a treatment for pain and fever in China since 500 BC. It contains the substance salicin, which is chemically related to aspirin. Another ingredient of white willow, tremulacin, may also be important.
In a 4-week, double-blind, placebo-controlled study of 210 individuals with chronic back pain, two different doses of willow bark extract were compared against placebo.5 The higher-dose group received extract supplying 240 mg of salicin daily; in this group, 39% were pain-free for at least the last 5 days of the study. In the lower-dose group (120 mg of salicin daily), 21% became pain-free. In contrast, only 6% of those given placebo became pain-free. Stomach distress did not occur in this study. The only significant side effect seen was an allergic reaction in one participant given willow.
Note: White willow should not be combined with standard anti-inflammatory drugs, such as ibuprofen. For more information, including dosage and safety issues, see the full White Willow article.
Chiropractic spinal manipulation is one of the most popular treatments for acute and chronic back pain in the US, and it may provide at least modest benefit; however, as yet, research evidence has failed to find chiropractic manipulation convincingly more effective than standard medical care.49,50,76
Chiropractic does seem to be more effective than placebo, if not by a great deal. For example, a single-blind, controlled study of 84 people suffering from low back pain compared manipulation to treatment with a diathermy machine (a physical therapy machine that uses microwaves to create heat beneath the skin) that was not actually functioning.16 The researchers asked the participants to assess their own pain levels within 15 minutes of the first treatment, then 3 and 7 days after treatment. The only statistically significant difference between the two groups was within 15 minutes of the manipulation. (Chiropractic had better results at that point.)
In another single-blind, placebo-controlled study, researchers assigned 209 participants to one of three groups: a high-velocity, low-amplitude (HVLA) spinal manipulation; a sham manipulation group; or a back education program.17 Though this has been reported as a positive study,18 most of the differences seen between the groups were too small to be statistically significant.
Unimpressive results were also seen in a well-designed study of 321 people with back pain, comparing chiropractic manipulation, a special form of physical therapy (the Mackenzie method), and the provision of an educational booklet in treating low back pain.25 All groups improved to about the same extent.
Several studies evaluated the effectiveness of chiropractic manipulation combined with a different kind of treatment called mobilization, but they too found little to no benefit.43,45,46
On a positive note, one study of 100 people with back pain and sciatica symptoms (pain down the leg due to disc protrusion) found that chiropractic manipulation was significantly more effective at relieving symptoms than sham chiropractic manipulation.57
For low back pain, several studies have found that chiropractic is at least as helpful as other commonly used therapies, such as muscle relaxants, soft-tissue massage, and physical therapy.22-26,51,74 Furthermore, in one well-designed study, 2 months of chiropractic spinal manipulation produced somewhat greater pain relief than exercise therapy, and this relative superiority endured to the 1-year follow-up point.41
For more information, see the full Chiropractic article.
The ancient technique of acupuncture has become increasingly popular as a treatment for pain and other conditions. However, thus far, research has not produced clear evidence of acupuncture’s effectiveness for back pain.52 In a review of 23 randomized trials involving over 6,000 patients with chronic low back, researchers concluded that acupuncture is more effective than no treatment for short-term pain relief, but there was no significant difference between the effects of true and sham.79
A 6-month, double-blind trial of 1,162 people with back pain compared real acupuncture, fake acupuncture, and conventional therapy.72 Both real and fake acupuncture were twice as effective as conventional therapy according to the measures used. However, there was only a minimal difference between real and fake acupuncture. These results do not, in fact, indicate that acupuncture is effective per se; rather, it shows the significant power of acupuncture as a placebo.
Similarly, in a single-blind, sham-acupuncture, and no-treatment controlled study of 298 people with chronic back pain, use of real acupuncture failed to prove significantly more effective than sham-acupuncture.58 Also, in a fairly large randomized trial involving 638 adults with chronic back pain, there was no difference in pain at one year in patients receiving real compared to fake acupuncture (with neither group improving significantly over standard care). Both real and simulated acupuncture were, however, associated with improved function at one year.80 Other studies have failed to find benefit as well; in several controlled studies enrolling a total of over 300 people, real acupuncture again failed to prove more effective than sham-acupuncture or other placebo treatments.19,29,32,53
One study compared the effects of acupuncture, massage, and education (such as videotapes on back care) for 262 people with chronic back pain over a 10-week period.28 The exact type of acupuncture and massage was left to practitioners, but only 10 visits were permitted. At the 10-week point, evaluations showed benefit with massage but not with acupuncture. One year later, massage and education were nearly equivalent, and both were superior to acupuncture.
Low level laser therapy (LLLT) is a technique similar to electro-acupuncture that uses precision laser energy instead of electricity conducted through a needle. In a detailed review of 7 randomized trials, researchers were unable to draw any conclusions regarding the effectiveness of LLLT for nonspecific low back pain.73 A randomized trial of 144 adults with chronic nonspecific low back pain found no differences in pain or disability when comparing low- and high-dose laser acupuncture to sham treatments over 8 weeks.92
A review of 32 randomized trials compared acupuncture to no or other therapies with mixed results in patients with nonspecific chronic low back pain. For pain reduction and function, acupuncture was better than sham acupuncture. Acupuncture was more effective for functional improvements when it was used in combination with usual care. Modest improvements in pain and function were seen with acupuncture treatment when compared to pain relievers and muscle relaxants, but the differences were not clinically significant. Biases included types of acupuncture used, duration of treatment, and number of treatment sessions in the patient population. Increased numbers of biases in trials affects the quality of the results.91
Many other studies have compared acupuncture to such treatments as transcutaneous electrical nerve stimulation (TENS), physical therapy, chiropractic care, and massage.14,33-37,59 In many of these trials, acupuncture provided benefits comparable to the other options tested. However, because TENS, physical therapy, and so forth, have not been proven effective for back pain, studies of this type cannot be taken as evidence that acupuncture is effective. One study did find acupressure massage more effective than standard physical therapy; however, it was performed in a Chinese population that may have had more faith in this traditional approach than in physical therapy.60
For more information, see the full Acupuncture article.
Other Proposed Natural Treatments TOP
In a double-blind, placebo-controlled study enrolling 215 people with back pain, use of a topical cream made from the herb comfrey produced statistically significant benefits as compared to placebo.61 A second randomized trial of 379 people with acute back pain also found a topical combination of comfrey and methyl nicotinate cream reduced back pain (at rest and with movement), decreased functional impairment, and reduced use of rescue medication compared to methyl nicotinate cream alone or placebo.90 Topical comfrey was associated with reduced back pain (upper and lower) compared to placebo in a randomized trial with 120 adults.93
The herb devil's claw is used for the treatment of osteoarthritis, and has been tried for back pain as well. However, the results have been less than impressive. A double-blind, placebo-controlled study of 197 individuals with chronic back pain found devil's claw only marginally effective at best.38 Similarly poor results were seen in an earlier 4-week, double-blind, placebo-controlled study of 118 individuals with acute back pain.39 However, a 4-week, double-blind, placebo-controlled study of 63 people with mild to moderate chronic muscular tension in the neck, back, and shoulders did find some benefit.27
The herb cayenne contains capsaicin, a substance that produces an immediate burning sensation but later reduces pain. One double-blind study found a topical cayenne treatment more effective than placebo in 320 people with low back pain.54 However, on the face of it, one finds it difficult to believe that this study was truly double-blind. When cayenne is applied to the skin, it causes such an intense sensation that participants could hardly fail to notice it. When people in a study know whether they are getting real treatment or placebo treatment, the validity of the study's results is greatly decreased. In another randomized trial of 40 people with low back pain, a topical cayenne-based cream was associated with reduced acute low back pain compared to placebo.43
A randomized trial with 200 patients found collagen hydrolysate significantly reduced joint pain when compared to placebo. Patients, who were followed for 6 months, were over 50 years old with hip, knee, elbow, shoulder or lumbar spine pain.87
Osteopathic manipulation (OM) is a form of treatment related to chiropractic manipulation, but it tends to use gentle, extended movements (low velocity, high amplitude) rather than the quick, short, cracking movements of chiropractic. OM has shown some promise for the treatment of back pain,15,20,40 including a randomized trial of 455 patients. The trial assessed the effects of 6 OM sessions over 8 weeks compared to sham treatments. At 12 weeks, OM was associated with moderate or substantial pain reduction compared to sham OM. OM also reduced the use of prescription pain medications.89
However, one of the best-designed trials failed to find it a superior alternative to conventional medical care. In this 12-week study of 178 individuals, osteopathic manipulation proved no more effective than standard treatment for back pain.40 Another study failed to find OM more effective than sham manipulation.55
In a review of 13 randomized trials, researchers concluded that massage may be effective for nonspecific low back pain, and the beneficial effects can last for up to 1 year in patients suffering from chronic pain.77 They also noted that exercise and education appear to enhance the effectiveness of massage. A subsequent large study involving 401 adults (aged 20-65 years old) with nonspecific back pain also supports the use of massage.84 The patients were randomized to one of three groups: structural massage, relaxation massage, or usual care. At 10 weeks, those in the massage groups had improved function and fewer symptoms compared to the usual care group. But unlike the previous review, there were no differences, though, at weeks 26 and 52. See the article on Massage for more details.
The Alexander Technique is a special method of postural training popular among dancers and other performers. A review of the literature found no more than weak preliminary evidence that Alexander may help with back pain, but concluded that further research is warranted.56 A subsequent controlled trial involving 579 patients with chronic or recurrent low back pain found that Alexander technique lessons, particularly when combined with exercise, was more effective than normal care or massage after one year.78
Tai Chi TOP
Tai Chi is a traditional form of martial art that involves gentle, dance-like movements. In one trial, 160 people with low back pain were randomized to do Tai Chi (18 sessions lasting 40 minutes each over a period of 10 weeks) or usual care.85 Those who participated in Tai Chi experienced a greater improvement in their symptoms, including less pain and less disability. However, the lack of an attention control group diminishes the reliability of these results.
The use of prolotherapy to treat back pain has had mixed results in clinical studies.
Invented in the 1950s by George Hackett, prolotherapy is based on the theory that chronic pain is often caused by laxness of the ligaments that are responsible for keeping a joint stable. When ligaments and associated tendons are loose, the body is said to compensate by using muscles to hold the joint stable. The net result, according to prolotherapy theory, is muscle spasms and pain.
Prolotherapy treatment involves injections of chemical irritant solutions into the area around such ligaments. These solutions are believed to cause tissue to proliferate (grow), increasing the strength and thickness of ligaments.9,10,11 This presumably serves to tighten up the joint and allow the associated muscles to stop having spasms. In the case of arthritic joints, increased ligament strength would allow the joint to function more efficiently, reducing pain.
In a review of five studies, three found prolotherapy to be no more effective than control treatments for treating low back pain. The other two studies suggested that prolotherapy was more effective than control treatments when used with therapies such as spinal manipulation and exercise.81 Another review suggested prolotherapy may be effective when used with other therapies, but not when used alone.82
What can one make of this contradictory evidence? When used alone prolotherapy is probably no more effective than a placebo injection for the treatment of chronic low back pain. However, there is some evidence that the technique may be beneficial when combined with other therapies.
For more information, see the full Prolotherapy article.
Other Therapies TOP
Biofeedback,21balneotherapy,66-67hatha yoga,62, 63,75magnet therapy,70,71 and relaxation therapies69,83,99 have also shown at least a hint of promise for treating back pain. Though for some of these, there have been as many negative as positive studies, and for many of them only short-term benefits were shown.
In one interesting study, 444 people with acute low back pain were randomly assigned to receive either usual care or usual care plus a choice of alternative therapies (chiropractic, acupuncture, or massage).68 The results showed that while the use of alternative therapies improved patient satisfaction, it did not significantly improve symptoms.
Yoga had positive effect on chronic low back pain in a randomized trial of 80 patients. Patients randomized to treatment with a yoga program showed improvement in pain, depression, and anxiety symptoms compared to patients in physical therapy. The program was carried out in a residential setting over seven days and included technique, counseling, and educational lectures.86 Yoga had a minimal, but positive effect on chronic low back pain in a review of 12 radomized trials with 1,080 patients. Yoga was compared to no-exercise alternatives and participants were not blinded, meaning they knew which treatment they were getting. There was no clinical improvement with pain and function. It wasn't clear if yoga was better than no exercise or if adding yoga to exercise was better.98
Pilates showed symptom improvement in a small randomized trial involving 31 sedentary women with nonstructural scoliosis. Twenty-four 60-minute sessions of Pilates twice weekly was associated with decreased degree of scoliosis, improved trunk flexion range of motion, and decreased pain compared to no therapy.88
Dry cupping involves placing cups on the skin and then removing the air from the cups to create a vacuum. This may help improve blood flow, or ease pain or inflammation. In a randomized trial, dry pulsatile cupping (use of a pump device to create the vacuum) was compared to minimal cupping (weak pressure) or no cupping for 110 adults with chronic low back pain. Significant pain reduction was seen in those who had dry pulsatile cupping compared to those who had minimal or no cupping after 4 weeks. Only dry pulsatile cupping showed benefits after 12 weeks.100
References[ + ]
1. Clinical Practice Guideline Number 14: Acute Low Back Problems in Adults. Rockville, Md: Agency for Health Care Policy and Research, US Dept of Health and Human Services; 1994. AHCPR publication 95-0642.
3. Carey TS, Garrett J, Jackman A, et al. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med. 1995;333:913-917.
4. Kendrick D, Fielding K, Bentley E, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001;322:400-405.
5. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9-14.
9. Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag. 1999;12:26-28.
10. Liu YK, Tipton CM, Matthes RD, et al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95-102.
11. Reeves KD. Prolotherapy: present and future applications in soft tissue pain and disability. Phys Med Rehab Clin North Am. 1995;6:917-926.
12. Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-146.
13. Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.
14. Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers—a randomized controlled clinical trial in a 2×2 factorial design [in German; English abstract]. Forsch Komplementarmed Klass Naturheilkd. 2000;7:286-293.
15. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.
16. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Med. 1974;31:59-64.
17. Triano JJ, McGregor M, Hondras MA, et al. Manipulative therapy versus education programs in chronic low back pain. Spine. 1995;20:948-955.
18. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.
19. Leibing E, Leonhardt U, Koster G, et al. Acupuncture treatment of chronic low-back pain—a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain. 2002;96:189-196.
20. Newswanger DL, Patel AT, Ogle A. Osteopathic medicine in the treatment of low back pain. Am Fam Physician. 2000;62:2414-2415.
21. Nielson WR, Weir R. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain. 2001;17:S114-127.
22. Hoehler FK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. JAMA. 1981;245:1835-1838.
23. Pope MH, Phillips RB, Haugh LD, et al. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine. 1994;19:2571-2577.
24. Hadler NM, Curtis P, Gillings DB, et al. A benefit of spinal manipulation as adjunctive therapy for acute low back pain: a stratified controlled trial. Spine. 1987;12:702-706.
25. Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021-1029.
26. Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low back pain. Ann Intern Med. 1992;117:590-598.
27. Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor and vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10-18.
28. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.
29. Mendelson G, Selwood TS, Kranz H, et al. Acupuncture treatment of chronic back pain. A double-blind placebo controlled trial. Am J Med. 1983;747:49-55.
30. Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Can Anaesth Soc J. 1976;23:303-306.
31. Baxter GD, Kerr DP, Walsh DM. Acupuncture in the management of chronic low back pain: a blinded randomised controlled trial [abstract]. FACT. 2001;6:70-71.
32. Duplan B, Cabanel G, Piton JL, et al. Acupuncture st lombosciatique a la phase aigue. Semin Hop Paris. 1983;59:310-3114. Cited by: Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.
33. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain. 1999;82:9-13.
34. Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbagia and ischialgia. Am J Chin Med. 1976;4:169-175.
35. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther. 1999;22:376-381.
36. Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.
37. Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79:331-335.
38. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anaesthesiol. 1999;16:118-129.
39. Chrubasik S, Zimpfer CH, Schutt U, et al. Effectiveness of Harpagophytum procumbens in treatment of acute low back pain. Phytomedicine. 1996;3:1-10.
40. Andersson GB, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426-1431.
41. Aure OF, Hoel Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525-531.
42. Schiller L. Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial. J Manipulative Physiol Ther. 2001;24:394-401.
43. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ. 1991;303:1298-1303.
44. Klein G, Kullich W. Reducing pain by oral enzyme therapy in rheumatic diseases [translated from German]. Wien Med Wochenschr. 1999;149:577-580.
45. Jayson MIV, Sims-Williams H, Young S, et al. Mobilization and manipulation for low-back pain. Spine. 1981;6:409-416.
46. Farrell JP, Twomey LT. Acute low back pain. Comparison of two conservative treatment approaches. Med J Aust. 1982;1:160-164.
47. Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-1259.
48. Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004;29:9-16.
49. Assendelft WJJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Int Med. 2003;138:871-881.
50. Ferreira ML, Ferreira PH, et al. Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. J Manipulative Physiol Ther. 2003;26:593-601.
51. Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004;27:388-398.
52. Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Int Med. 2003;138:898-906.
53. Kerr DP, Walsh DM, Baxter D. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Clin J Pain. 2003;19:364-370.
54. Frerick H, Keitel W, Kuhn U. Topical treatment of chronic low back pain with a capsicum plaster. Pain. 2003;106:59-64.
55. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-1362.
56. Ernst E, Canter PH. The Alexander Technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd. 2003;10:325-329.
57. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131-137
58. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006;166:450-457.
59. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]
60. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]
61. Kucera M, Barna M, Horacek O, et al. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study. Adv Ther. 2005;22:681-692.
62. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107-117.
63. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. A randomized, controlled trial. Ann Intern Med. 2005;143:849-856.
64. Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;CD000335.
65. van Tulder MW, Koes B, Malmivaara A, et al. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2005 Dec 1. [Epub ahead of print]
66. Pittler MH, Karagulle MZ, Karagulle M, et al. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford). 2006;45:880-884.
67. Balogh Z, Ordogh J, Gasz A, et al. Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd. 2005;12:196-201.
68. Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007;32:151-158.
69. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain. 2007 May 31. [Epub ahead of print]
70. Khoromi S, Blackman MR, Kingman A, et al. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. J Pain Symptom Manage. 2007 Jul 6. [Epub ahead of print]
71. Collacot EA, Zimmerman JT, White DW, et al. Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study. JAMA. 2000;283:1322-1325.
72. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892-1898.
73. Yousefi-Nooraie R, Schonstein E, Heidari K, et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database of Systematic Reviews. 2008;(2):CD005107.
74. Wilkey A, Gregory M, Byfield D, et al. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Altern Complement Med. 2008;14:465-473.
75. Tekur P, Singphow C, Nagendra HR, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14:637-644.
76. Juni P, Battaglia M, Nuesch E, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2008 Sep 5.
77. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.
78. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ. 2008;337:a884.
79. Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.
80. Cherkin DC, Sherman KJ, AVins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858-866.
81. Dagenais S, Yelland M, Del Mar C, Schoene M. Prolotherapy injections for chronic low back pain. Cochrane Database of Systematic Reviews. 2007;2.
82. Dagenais S, Mayer J, Haldeman S, Borg-Stein J. Evidence-informed management of chronic low back pain with prolotherapy. Spine J 2008 Jan-Feb;8(1):203-12.
83. Esmer G, Blum J, Rulf J, Pier J. Mindfulness-based stress reduction for failed back surgery syndrome: a randomized controlled trial. J Am Osteopath Assoc. 2010;110(11):646-652.
84. Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155(1):1-9.
85. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken). 2011;63(11):1576-1583.
86. Tekur P, Nagarathna R, Chametcha S. A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT. Complement Ther Med. 2012;20(3):107-118.
87. Bruyere O, Zegels B, Leonori L, et at. Effect of collagen hydrolysate in articular pain: a 6-month randomized, double-blind, placebo controlled study. Complement Ther Med. 2012;20(3):124-130.
88. Alves de Araújo ME, Bezerra da Silva E, Bragade Mello D, et al. The effectiveness of the Pilates method: reducing the degree of non-structural scoliosis, and improving flexibility and pain in female college students. J Bodyw Mov Ther. 2012;16(2):191-198.
89. Licciardone JC, Minotti DE, et al. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Am Fam Med 2013;11(2):122-129.
90. Pabst H, Schaefer A, et al. Combination of comfrey root extract plus methyl nicotinate in patients with conditions of acute upper or low back pain: a multicentre randomised controlled trial. Phytother Res. 2013;27(6):811-817.
91. Lam M, Galvin R, et al. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976):2014;38(24):2124-2138.
92. Glazov G, Yelland M, et al. Low-dose laser acupuncture for non-specific chronic low back pain: A double-blind randomised controlled trial. Acupunct Med. 2014;32(2):116-123.
93. Oltean H, Robbins C, et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014;12:CD004504.
94. Hartvigsen J, Morso L, Bendix T, Manniche C. Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial. BMC Musculoskelet Disord. 2010;11:30.
95. Krein SL, Kadri R, Hughes M, et al. Pedometer-based internet-mediated intervention for adults with chronic low back pain: randomized controlled trial. J Med Internet Res. 2013;15(8):e181.
96. Hurley DA, Tully MA, Lonsdale C, et al. Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092). Pain. 2015;156(1):131-147.
97. Lawford BJ, Walters J, Ferrar K. Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review. Clin Rehabil. 2016;30(6):523-526.
98. Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;1:CD010671.
99. Morone NE, Greco CM, Moore CG, et al. A mind-body program for older adults with chronic low back pain: a randomized clinical trial. JAMA Intern Med. 2016 Mar;176(3):329-337.
100. Teut M, Ullmann A, Ortiz M, et al. Pulsatile dry cupping in chronic low back pain—a randomized three-armed controlled clinical trial. BMC Complement Altern Med. 2018;18(1):115.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 7/6//2018
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at firstname.lastname@example.org. Our Health Library Support team will respond to your email request within 2 business days.