The Best Treatment for Back Pain According to the Best Evidence

The vast majority of back pain is functional- meaning the pain is because the back is not functioning correctly.  Accordingly, it makes since that back pain treatment strategies should focus on discovering and addressing the movement-related back pain. Unfortunately, many people with back pain are over diagnosed with a structural problem (such as scoliosis, spine degeneration), are given pain medications that fail to address function, and are instructed to concede activity.  It is certainly prudent to address symptoms and temporarily modify activity during an episode of back pain, but this is no replacement for treatment that rehabilitates low back function.

Research into the Best Treatment for Low Back Pain

The Annals of Internal Medicine published a study investigating massage therapy compared to medical care for chronic back Pain.  Low back pain can affect up to 80% of the population. When a doctor treats low back pain, the main goal is to decrease the pain and help the individual return to their usual activities. Those with low back pain may be confused by the different treatments that are offered by different medical specialist. Doctors of chiropractic, medical doctors, physical therapist, and massage therapists have different tools to address back pain.

Massage Therapy Compared to Medical Care for Chronic Back Pain

Usual Medical Care for Back Pain

The medical researchers in this study compared “usual medical treatment” to massage therapy for back pain lasting for more than three months in 401 individuals. For purposes of the study, they defined usual medical care as pain killers, anti-inflammatory drugs, muscle relaxants, back exercises, and education about ways to deal with the current back pain and prevent future back pain.

First, the researchers measured the participants’ symptoms and the effect of their back pain upon their daily activities. The participants were randomly assigned to the “massage group” or the “usual medical treatment group”. Those in the massage group received a one-hour massage once a week for 10 weeks. The effects were measured after 10 weeks, 6 months, and 12 months.

Massage vs. Medical Care for Back Pain

The researchers discovered that those with low back pain who received massage therapy had less pain and were better able to perform daily activities than those treated with “usual medical care.” Both pain and performance were still improved for those receiving massage at six months and at 12 months.  After 12 months, those in the usual medical care group were doing just as well as those who had received massage therapy.

In summary, those receiving massage for chronic low back pain enjoyed more rapid improvement in their pain and daily function than those receiving “usual medical care”. It is important to acknowledge that there is no cookie-cutter approach for a health professional applying treatment to a back pain. Each chronic back pain syndrome is unique, and should be thoroughly evaluated before treatments are recommended.

Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA. 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 Jul 5;155(1):1-9.

What about Pain Medication for Back Pain?

A lot of people are confused about what to do when confronted with an episode of low back pain. Unfortunately, that confusion also extends into the healthcare system, such that some patients don’t get effective, evidence-based back pain treatment.

As scientists find the most effective treatments for spine problems, other researchers aggregate that information to form clinical practice guidelines. Clinical practice guidelines for the treatment of acute mechanical low back pain are based upon sound scientific evidence rather than on consensus.

The recommended guidelines for evidence based back pain treatment:

  1. Avoid narcotic pain medication
  2. Avoid passive treatments (such as bed rest, heat, or back braces)
  3. Pursue an aerobic exercise program
  4. Use of a short course of non-steroidal anti-inflammatory drugs (Tylenol, Advil) unless medically contraindicated
  5. Use lumbar spine manipulation therapy (chiropractic manipulation)
  6. Receive education and reassurance about low back pain

So a study in 2010 published in The Spine Journal analyzed the treatment of 92 patients with new onset low back pain. Half of the patients were treated via “usual care” at a major hospital system and failed to receive treatment consistent with evidence-based guidelines. (see table below)

Frequencies of use of reported treatment

The other half of the patient group received evidence-based treatment including exercise, anti-inflammatory medication (NSAIDs), reassurance, and manipulation.  Compared to the “usual care” group, those receiving the evidence-based treatment including chiropractic spinal manipulation therapy had significantly greater improvement in low back function 8, 16, and 24 weeks later.

Commenting on the study, the journal editors wrote, “This study offers some insight into high rates of opioid in passive methods for acute low back pain employed in “usual care” at a university-based hospital. The results of avoiding some well-documented treatment pitfalls and using the evidence-based guideline method appear promising. The study also provides evidence that the actual implementation of guideline recommendations may be truly beneficial to patients, themselves, and not just to payers’ strategy to minimize costs.”

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3 Responses to The Best Treatment for Back Pain According to the Best Evidence

  1. Mark Josefsberg July 5, 2015 at 10:07 am #

    Adding the Alexander Technique to your daily life can help you avoid pain, and lessens the intensity if you do experience pain.
    The Alexander Technique works for the neck too, because it’s all the same spine.

  2. Erick April 9, 2014 at 8:02 pm #

    Thank you for this! I have had recurring back pain for years, and Army doctors continually gave me bed rest. It was a smart PT that told me to get moving, and it got better! I even came back stronger than before!

    • Dr. Brad Cole April 10, 2014 at 7:35 am #

      “stronger than before!” That’s the goal of rehab. To fix inefficiencies and make one more durable. Great job and keep moving well.

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