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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest. For health professionals.

Chronic Low-Back Pain and Complementary Health Approaches

March 2014
Patient holding back in pain

This issue of the digest summarizes current scientific evidence about spinal manipulation, acupuncture, massage, and yoga, the complementary approaches most often used by people for chronic low back pain.

  • Evidence-based clinical practice guidelines from the American College of Physicians and the American Pain Society (ACP/APS) provide a useful algorithm for diagnosis and treatment of patients with chronic low back pain. In general, the guidelines recommend a conservative approach to diagnosis and treatment, except when patients have progressive neurologic deficits or cauda equina syndrome, or are suspected of having underlying conditions requiring urgent intervention (e.g., vertebral infection or cancer with impending spinal cord compression).
  • The systematic review supporting these recommendations (Cho and Huffman, Ann Intern Med. 2007;147(7):492–504) found:
    • Good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (>4 weeks' duration) low back pain.
    • Fair evidence that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain.
  • The guidelines recommend that practitioners consider these non-pharmacological interventions as appropriate options when treating patients whose low-back pain does not improve with more conservative self-care.
  • Interpreting and summarizing current evidence about diagnosis and treatment of chronic low back pain is particularly challenging because of major differences in patient populations, eligibility criteria, diagnostic studies, treatments, and outcome measures across different studies, and the variety of health care professions involved in care of patients. Learn about NIH initiatives to address this problem.

Time to Talk Tips: 5 Things To Know About Chronic Low-Back Pain and Complementary Health Practices

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NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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