Low-Back Pain and CAM: What the Science Says Spinal Manipulation

• Overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines [494KB PDF], the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when back pain does not improve with self-care.

• Research is under way to determine whether the effects of spinal manipulation depend on the duration and frequency of treatment. Recent studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year.

• In one study funded by the National Center for Complementary and Alternative Medicine (NCCAM) that examines long-term effects in more than 600 people with low-back pain, results suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months. However, less than 20 percent of participants in this study were pain free at 18 months, regardless of the type of treatment used. Acupuncture

• According to clinical practice guidelines issued by the American College of Physicians and the American Pain Society in 2007, acupuncture is one of several CAM therapies physicians should consider when patients with chronic low-back pain do not respond to conventional treatment.

• In early, small studies, combining actual acupuncture with conventional treatment was more effective than conventional treatment alone for relieving chronic low-back pain. However actual acupuncture was not more effective than simulated acupuncture or conventional treatment.

• A large, rigorously designed clinical trial reported in May 2009 found that actual acupuncture and simulated acupuncture were equally effective—and both were more effective than conventional treatment—for relieving chronic low-back pain.

• There is insufficient evidence to draw definite conclusions about the effectiveness of acupuncture for acute low-back pain.

Massage

• Results of an NCCAM-funded study showed that massage therapy may have short term benefits for people with chronic low-back pain. Massage therapy helped reduce pain and improve function more rapidly than usual medical care at 10 weeks; however, at 1 year the benefits of massage over usual care were not significant.

• A 2008 review of 13 clinical trials found evidence that massage might be useful for chronic low-back pain.

• Clinical practice guidelines issued in 2007 by the American College of Physicians and the American Pain Society recommend that physicians consider using certain CAM therapies, including massage (as well as acupuncture, chiropractic, progressive relaxation, and yoga), when patients with chronic low-back pain do not respond to conventional treatment.

Other CAM Approaches

• Reviews of research on other CAM therapies that people sometimes use for chronic low-back pain, such as various herbal remedies and prolotherapy injections, generally have found limited or no evidence to support their use for this purpose, or the evidence is mixed.

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS.