National Center for Complementary and Alternative Medicine (NCCAM)

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Josephine P. Briggs, M.D.
Josephine P. Briggs, M.D.

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Josephine P. Briggs, M.D.

Oh My Aching Back!

November 25, 2009

Oh, my aching back! I am sure you have all heard this from a family member—or said it yourself.

In previous messages, I've mentioned the high use of complementary and alternative medicine (CAM) for treating back pain. Back pain is a very common and bothersome symptom; it is a symptom that really matters and a major health burden in the United States. It is the leading cause of work-related disability and missed days of work, the fifth-most-common reason for physician visits, and a leading factor in health care costs.

According to the 2007 National Health Interview Survey, back pain is the most common condition for which adults use CAM. Patients with back pain turn to CAM with the hope of decreasing pain, improving function and quality-of-life, preventing recurrence and chronicity, or avoiding side effects of treatments. The CAM approaches used for back pain include chiropractic and osteopathic manipulation, massage, yoga, relaxation techniques, meditation, acupuncture, and herbal supplements. It's clear the public is searching for nonsurgical, nonpharmacologic therapies to help their aching backs.

There are many options and possible treatments for the management of back pain, and physicians differ widely in what they recommend to their patients. In part to address these disparities, in 2007, the American College of Physicians and the American Pain Society (ACP/APS) issued a joint clinical guideline on the diagnosis and treatment of low back pain. This guideline was the culmination of a careful systematic review of the literature. In this guideline, the societies included a recommendation to «[consider] nonpharmacologic therapy that has proven benefits for patients whose low back pain does not improve with self-care alone.» For acute low back pain, the guidelines point to spinal manipulation and conclude it has small-to-moderate, short-term benefit. For chronic low back pain, the guidelines list a number of therapies that have fair-to-good supporting evidence for moderate effectiveness, including acupuncture, massage therapy, progressive relaxation, and Viniyoga-style yoga.

Clinical practice guidelines such as the ACP/APS recommendation represent the apex of the hierarchy of evidence-based medicine. They tell us that there is a growing evidence base about the role of these CAM approaches in treating this challenging condition. We are proud that NCCAM's researchers have contributed substantially to this evidence base.

But we can't stop here. The reality is that there are still a lot of people with aching backs. Pain conditions, including low back pain, are some of hardest to treat. We still have much to learn about the effectiveness and safety of CAM therapies for back pain, although we are now seeing that these approaches offer promise.

NCCAM plans to continue to invest in back pain research. As one of the co-chairs for the NIH Pain Consortium (a trans-NIH effort to further develop a forward-thinking pain research agenda), I am enthusiastically pursuing opportunities for cross-NIH collaboration. As NCCAM moves forward, I am hopeful that our rigorous research on CAM therapies for back pain will offer additional treatment options and assist everyone with an aching back to make informed health care decisions.

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