National Institutes of Health • National Center for Complementary and Alternative Medicine
Chronic Pain and Complementary Health Practices—Low-Back Pain
What the Science Says
Acupuncture, Massage, and Spinal Manipulation for Low-Back Pain
- Reviews of research on acupuncture, massage, and spinal manipulation for chronic low-back pain have found evidence that these therapies may be beneficial.
- Clinical practice guidelines issued by the American College of Physicians/American Pain Society in 2007 recommend these therapies and five other nonpharmacologic (nondrug) approaches for patients with back pain who do not improve with medication, education, and self-care (the other recommended approaches are cognitive-behavioral therapy, exercise therapy, progressive relaxation, intensive interdisciplinary rehabilitation, and yoga).
- Reviews of research on other complementary health practices that people sometimes use for chronic low-back pain, such as various herbal remedies and prolotherapy injections, generally have found limited or no evidence to support their use for this purpose, or the evidence is mixed.
- Acupuncture has few associated risks, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.
- Massage therapy appears to have few serious risks—if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils.
- Reviews have concluded that spinal manipulation for low-back pain is relatively safe when performed by a trained and licensed practitioner. The most common side effects are generally minor and include feeling tired or temporary soreness. Reports indicate that cauda equina syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems, may be an extremely rare complication of spinal manipulation. However, it is unclear if there is actually an association between spinal manipulation and CES, since CES usually occurs without spinal manipulation. There may be additional risks associated with spinal manipulation affecting the upper (cervical) spine, but that area of the spine is generally not manipulated when treating low-back pain. See the NCCAM fact sheet Chiropractic: An Introduction for more information on risks.
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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