Low Back Pain

Other Treatment

You can choose from a number of alternative therapies for treating your low back pain. Some are short-term "repair" treatments, and others give you the self-care tools for managing your back symptoms over a lifetime. Because many of these treatments are new or not yet well researched, they may not be covered by health insurance.

Comprehensive rehabilitation programs offer a variety of treatments and specialists. A comprehensive rehabilitation program is considered one of the most effective approaches for treating chronic low back pain, and may be your best bet for finding the right combination of treatments.⁴

Other therapies for lower back treatment

• Exercise therapy for back pain is considered an effective approach for treating and managing chronic low back pain.⁴ Daily activity and physiotherapy exercises can be effective in relieving back pain and can lead to long-term improvement for low back pain. Also see:

  Core stabilization.

  Exercises for low back pain.

• Cognitive-behavioural therapy may reduce both acute and chronic low back pain and disability.^{2, 4}
• Back school is an educational program that has shown mixed results but is considered likely to be beneficial for treating chronic low back pain.⁴
• Intradiscal electrothermic therapy (IDET) treats chronic low back pain related to a damaged spinal disc.
• Spinal cord stimulation may be used for some types of chronic pain when other treatments have failed, but there is not strong evidence that it works.²⁰

Experimental treatments

New and experimental treatments are constantly being developed and offered to people with low back pain. If you are considering such a treatment, be sure to ask your doctor for the scientific evidence that shows the treatment's effectiveness and safety, as well as the results of his or her own practice.

The following therapies are experimental and not widely used. Research continues on these therapies.

• Surgery to replace a ruptured or herniated disc with an artificial disc has been approved by Health Canada. Long-term studies have not been done.²¹
• Botulinum toxin (Botox) injection may relax pain muscle spasms in the low back.
• Radiofrequency ablation of nerves may reduce chronic low back pain in some people by preventing pain signals from reaching the brain. It is sometimes used for pain from problems with the small joints in the spine called facet joints.
• An intrathecal pain pump is a small tube inserted under the skin and deeper tissues along the midline of the back, which connects to a small reservoir of medicine inserted under the skin of your belly. The medicine is regularly delivered to the area of pain through the tube. This method of pain control is not yet widely used, but results are promising.²²

Complementary therapies and self-care

The following complementary therapies are commonly used for relieving low back pain.

• Massage may reduce low back pain, especially when combined with exercises and back care education.²³
• Spinal manipulation is likely to help either acute or chronic low back pain.^{2, 4} While they differ in their training, osteopaths, chiropractors, physiatrists, and specially trained physiotherapists can all perform spinal manipulation. Spinal manipulation usually has its greatest impact after one treatment, so multiple treatments are seldom necessary.⁷ Learn more about chiropractic and osteopathic manipulative treatment. One comparison has shown that people receiving osteopathic manipulative treatment may need less medicine to control their pain than those receiving standard treatment such as pain medicine and physiotherapy.²⁴ For more information, see:

  Should I have spinal manipulative therapy to treat low back pain?

• Biofeedback has not been well studied as a treatment for low back pain. But recent research has not shown that biofeedback is effective for controlling low back pain.^{2, 4}
• Acupuncture may help decrease pain and increase activity. Some studies show that acupuncture reduced pain and disability related to back problems more than usual treatment.^{8, 9} Another summary of several studies showed that acupuncture reduced pain and increased the ability to be active, but not any more than other treatments.¹⁰
• Acupressure uses pressure on certain points in the body to decrease symptoms. Small studies suggest that acupressure reduces pain and allows a person to be more active.²⁵
• Relaxation techniques can help reduce muscle tension, stress, and depression.
• Yoga is another way of staying active, while also helping with relaxation and stress management. It is not clear whether yoga is more helpful than other activity or treatment for low back pain.²⁶ There are different types of yoga. Talk to your doctor or physiotherapist before you start a yoga program.

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Author:	Shannon Erstad, MBA/MPH Ralph Poore	Last Updated: March 31, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics Andrew Swan, MD, CCFP, FCFP - Family Medicine
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