From Our 2007 Archives

Low Back Pain: Many Options for Relief

Expert Panel Says a Variety of Treatments Can Ease Pain Without Surgery

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Oct. 1, 2007 -- People who suffer low back pain have high odds of finding relief without surgery, an expert panel says.

The panel, made up of experts from the American Pain Society and the American College of Physicians, has released guidelines for the diagnosis and treatment of low back pain.

The guidelines cover what doctors call "nonspecific low back pain" -- that is, back pain not due to a specific condition such as cancer, a slipped disk, a compressed nerve, or a fracture.

If you have this kind of bad pain, there's good news, says panelist Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland. Chou is director of the clinical guidelines development program of the American Pain Society.

"There are lots of options out there that have pretty good evidence they work," Chou tells WebMD. "There is no one perfect treatment for everybody. If you are interested in spinal manipulation and acupuncture, the evidence is just as good as for medications."

Once upon a time, doctors told people with low back pain to stay in bed for three days -- perhaps with a board under their mattress. That very bad advice actually made back pain worse, Chou says.

"We don't want people lying in bed," he says. "Get out. Try a normal range of activities, but back off if your back hurts. But you won't hurt your back by doing regular stuff, and it may actually keep your back conditioned and strong."

Doctors also used to give routine X-rays to patients complaining of low back pain. That, according to the expert panel, alsois wrong. X-rays are indicated only when a doctor has reason to suspect an underlying condition that could be confirmed by imaging studies.

Back Pain Relief Menu

Most people with low back pain have an acute pain episode. But up to a third of patients report persistent pain of at least moderate intensity -- chronic low back pain.

The panel found evidence that different patients can get relief from a wide variety of treatments. These treatments include:

  • Cognitive-behavioral psychotherapy
  • Exercise therapy
  • Spinal manipulation from a chiropractor, osteopath, or physical therapist
  • Intensive interdisciplinary rehabilitation (physical, vocational, and behavioral therapies provided by multiple providers with different clinical backgrounds)
  • Acupuncture
  • Massage therapy
  • Yoga
  • Progressive relaxation

"Patients and doctors need to talk," Chou says. "Don't use stuff not backed up by evidence. Don't fall for stuff just because it's touted on the Internet or whatever."

Scott D. Boden, MD, professor of orthopaedic surgery and director of the Emory University orthopaedics and spine center, says the panel's advice confirms what back specialists have been saying for years.

"These programs have been around for 15 to 20 years," Boden tells WebMD. "Some studies show they have a benefit, some not. A lot of this has to do with the psychological makeup of patients."

Boden adds one more possible cure to Chou's list: time.

"Fortunately for most patients, it is just a short period of time where back pain is absolutely debilitating," he says. "For some, the most important thing is just the education that they are not falling apart, so they can to stop searching for the cure and go on and live their lives."

Both Boden and Chou stress that surgery is not the answer for most patients. In fact, Consumer Reports this month listed back surgery as the No. 1 most overused medical treatment.

"Since surgery doesn't offer a large advantage in most patients, the message is that most people will be able to get better without surgery," Chou says. "If you can avoid it, you are going to be better off."

Boden suggests that patients settle on a treatment that helps and warns that some patients may never be totally cured of back pain.

"Unfortunately, while looking for a cure patients can run into surgery that would be moderately risky with a small chance of success," Boden says. "Or they could end up with something that is not necessarily dangerous, but equally ineffective. There are a lot of new things that sound good, but the real back pain options really haven't changed that much in decades."

Chou and colleagues report the panel findings in the Oct. 2 issue of the Annals of Internal Medicine.

SOURCES: Chou, R. Annals of Internal Medicine, Oct. 2, 2007; vol 147: pp 478-491. Chou, R. Annals of Internal Medicine, Oct. 2, 2007; vol 147: pp 492-504. News release, American College of Physicians. Roger Chou, MD, associate professor of medicine, Oregon Health & Science University, Portland; director, clinical guidelines development program, American Pain Society. Scott D. Boden, MD, professor of orthopaedic surgery and director, orthopaedics and spine center, Emory University, Atlanta. Consumer Reports; November 2007.

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