Treatment for Chronic Low Back Pain

Treatment for Chronic Low Back Pain

Evidence strongly suggests that only intensive treatment using a combination of physical and psychological rehabilitation programs can reduce pain and improve function in patients with chronic low back pain. Even with the best treatments, many patients with chronic back pain fail to experience complete pain relief. They often must develop methods for improving daily life in the face of some persistent pain.

Noninvasive Therapies. In general, early treatments for severe low back pain or chronic low back pain are similar to those of acute uncomplicated low back pain. The following are the most common noninvasive treatments for chronic back pain of unknown causes:

• Pain Relievers. Pain relievers, particularly non-steroidal anti-inflammatory drugs (NSAIDs), may help relieve symptoms, although they can have severe effects on the gastrointestinal tract over time. Some doctors have recommended long-term opioids for patients with severe chronic pain, but studies suggest they do not improve activity levels and can have significant side effects.
• Corticosteroid injections may be helpful for some patients.
• Exercise and Physical Therapy. Specific and regular exercise under the guidance of a trained professional is important for reducing pain and improving function, although patients often find it difficult to sustain.
• Antidepressants. Tricyclic antidepressants may be helpful for some patients.
• Cognitive-Behavioral Therapy. This form of psychological therapy helps change behavior and attitudes toward pain.
• Alternative Therapies. Transcutaneous electrical nerve stimulation (TENS) and massage may relieve pain in certain cases. Other mind-body techniques such as relaxation and meditation may be helpful by reducing stress. Other promising approaches, such as Botox injections and lidocaine patches, are also being investigated.
• Acupuncture. A study in the British Medical Journal found that acupuncture provided longer lasting relief than physical therapy. For the study, 129 people were given either six acupuncture or physical therapy sessions. The study authors cautioned that the benefit of acupuncture greatly depended on the health care provider’s experience. Another study, published in the Archives of Internal Medicine, reported that acupuncture worked better than no treatment at all.
• Yoga. Yoga relieves low back pain better than conventional exercise or self-help books, according to a study published in the December 20, 2005 issue of Annals of Internal Medicine. For the study, 101 adults with low back pain who were randomly assigned to one of three groups. One group attended yoga classes and lessons; the second did aerobics, weight training, and stretching; and third group read a self-help book about back pain. After 12 weeks, those who took yoga could better perform daily activities requiring the back than those in the other two groups. After 26 weeks, those who took yoga had less pain and better back function, and used less pain relievers than the others.