Back Pain and Sciatica
A number of complementary and alternative treatments are used to relieve back pain. Complementary means it is used together with conventional medicine. Alternative means it is done in place of conventional medicine.
Acupuncture is now a common alternative treatment for certain kinds of pain. It involves inserting small needles or exerting pressure on certain "energy" points in the body. When the pins have been placed successfully, the patient is supposed to experience a sensation that brings a feeling of fullness, numbness, tingling, and warmth with some soreness around the acupuncture point. Unfortunately, rigorous studies of acupuncture are difficult to perform, and most evidence on its benefits is weak. In any case, it may be helpful for certain patients with back pain, such as pregnant women, who must avoid medications. Anyone who undergoes acupuncture should be sure it is performed in a reputable facility by experienced practitioners who use sterilized equipment.
Acupuncture has not shown any benefits for acute low back pain in most patients, but may provide some help for patients with chronic low back pain.
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Massage therapy can help some patients with chronic or acute back pain, especially when combined with exercise and patient education.
A course of cognitive-behavioral therapy can help reduce chronic back pain, or at least enhance the patient's ability to deal with it. The primary goal of this form of therapy in such cases is to change the distorted perceptions that patients have of themselves, and change their approach to pain. Patients use specific tasks and self-observations to help them change their thinking. They gradually shift their perception of helplessness against the pain that dominates their lives into the perception that pain is only one negative among many positives and, to a degree, a manageable experience.
Chiropractors typically perform spinal manipulations, but so do osteopathic doctors.
- One in three people with low back pain seeks treatment from a chiropractor. Chiropractic was founded in the U.S. in the late 1800s. The specific goal of chiropractors is to perform spinal manipulations to improve nerve transmission.
- Osteopathy was also founded in the 1800s, and its core approach to healing also involves physical manipulation. Osteopathy manipulates the bones, muscles, and tendons to optimize blood circulation. The general direction of osteopathy over the years has widened to employ a broader range of treatments, which now approach those of standard medicine.
Spinal Manipulation for Uncomplicated Low Back Pain.
There is limited evidence of benefit for spinal manipulation treatment of subacute pain and exacerbations of chronic pain. It has not been shown to offer additional benefit over usual care in acute back pain patients. Ongoing or maintenance spinal manipulation has not been proven to alter the course of chronic back pain.
Mild and temporary side effects from spinal manipulation are common. The potential for serious adverse effects from low back manipulations is low.
X-rays, particularly those of the full spine, are not generally needed and expose patietns to radiation. Patients should also be aware that some other alternative treatments provided by chiropractors have not been proven or rigorously studied.
Percutaneous Neuromodulation Therapy. A technique called percutaneous neuromodulation therapy (PNT) uses a small device that delivers electrical stimulation to deep tissues and nerve pathways near the spine through the skin.
Electrical Nerve Stimulation. Transcutaneous electrical nerve stimulation (TENS) uses low-level electrical pulses to suppress back pain. A variant of this procedure, percutaneous electrical nerve stimulation (PENS), applies these pulses through a small needle to acupuncture points. Both of these apply the stimulation through the skin.
When tested in high-quality studies, these electrical nerve stimulation techniques have not been found to provide much help for chronic low back pain.
Spinal cord stimulation. A more invasive technique involves delivering the electrical impulse through electrodes implanted on or next to the spinal column. It is only considered for patients with chronic radicular pain that is still present after surgery and other drug and non-invasive treatments have failed to help. The risks and benefits and high rate of complications of this type of stimulation should be discussed thoroughly with the surgeon.