Back pain and sciatica - Other Treatments

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of back pain, including sciatica.

Alternative Names

Herniated disk; Sciatica

Other Treatments:

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

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 specifically 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 location 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.

Click the icon to see an image of acupuncture.

Massage Therapy

Some studies have shown that massage therapy can help some patients with chronic or acute back pain, especially when combined with exercise and patient education.

Cognitive-Behavioral Therapy

Some studies report that a course of cognitive-behavioral therapy helps reduce chronic back pain, or at least enhances 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.

Spinal Manipulation

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. Many studies have now confirmed that patients feel more satisfied with their chiropractic care than with treatment from general practitioners.
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 evidence of benefit for spinal manipulation treatment of subacute pain and exacerbations of chronic pain. 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.

Some chiropractors may take a lot of x-rays, particularly those of the full spine, which may have long-term harmful consequences. Patients should also be aware that some chiropractors use alternative treatments that have not been proven or rigorously studied. All patients should require objective evidence on the benefits of their treatments.

Electrical Stimulation

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.

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.

When tested in high-quality studies, electrical nerve stimulation has not been found to provide much help.

Resources

www.niams.nih.gov -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.aaos.org -- American Academy of Orthopaedic Surgeons
www.arthritis.org -- Arthritis Foundation
www.spine.org -- North American Spine Society
www.apta.org -- American Physical Therapy Association
www.ampainsoc.org -- American Pain Society
www.theacpa.org -- American Chronic Pain Association
www.iasp-pain.org -- International Association for the Study of Pain

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Reviewed last on: 5/13/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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