Conservative Care for Low Back Pain

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Conservative Care for Low Back Pain

Conservative Care for Low Back Pain

A Brief Overview

Low back pain is a difficult to treat global health burden, one of the reasons for this is that there is often no clear identifiable cause. The strongest reviews support the need for a multi-modal therapeutic approach to manage low back pain. A multi-modal approach can involve a number of management strategies that include but is not limited to education, reassurance, analgesic medicines and a number of non pharmacological therapies.

Conservative Care for Low Back Pain

Recent recommendations from The Canadian Medical Association (Busse et al. 2017), The American College of Physicians (Chou et al. 2017, Qaseem et al. 2017), Center for Disease Control (Frieden et al. 2016), and The Mayo Clinic (Nahin et al. 2016) represent a monumental shift in pain management.

Physicians, now more than ever are recommending conservative treatment including massage, spinal manipulation, acupuncture and exercise as part of a multi-modal approach for patients suffering from low back pain, anxiety and stress.

Summaries from The American Medical Guidelines for Low Back Pain:

For new low back pain (lasting less than 12 weeks), try:
• heat
• massage
• acupuncture
• spinal manipulation

For chronic low back pain (lasting 12 weeks or more), try:
• exercise (including stretching, improving balance, and strengthening core muscles)
• physical therapy
• acupuncture
• mindfulness-based programs intended to cope with or reduce stress.
• tai chi, yoga, or progressive relaxation techniques may also be helpful.

More to Explore

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Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. (2017). Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy.
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Arguisuelas, M.D., Lisón, J.F., Sánchez-Zuriaga, D., Martínez-Hurtado, I., Doménech-Fernández, J. (2017). Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial. Spine.
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Busse, J.W., Craigie, S., Juurlink, D.N, ... Guyatt GH. (2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ.
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Cherkin, D.C., Sherman, K.J., ...Turner, J.A. (2016). Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA.
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Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., ... Brodt, E.D. (2017). Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med.
https://www.ncbi.nlm.nih.gov/pubmed/28192793

Elder, W.G., Munk, N., Love, M.M., Bruckner, G.G., Stewart, K.E., Pearce, K. (2017). Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study. Pain Med.
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Frieden, T. R., & Houry, D. (2016). Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline. New England Journal of Medicine.
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Herman, P.M., Anderson, M.L., Sherman, K.J., Balderson, B.H., Turner, J.A., Cherkin, DC. (2017). Cost-Effectiveness of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care among Adults with Chronic Low-Back Pain. Spine (Phila Pa 1976). 
https://www.ncbi.nlm.nih.gov/pubmed/28742756

Kumar, S., Beaton, K., & Hughes, T. (2013). The effectiveness of massage therapy for the treatment of nonspecific low back pain: A systematic review of systematic reviews. International Journal of General Medicine.
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Layne, E.I., Roffey, D.M., ... Wai, E.K. (2017). Activities performed and treatments conducted prior to consultation with a spine surgeon: Are patients and clinicians following evidence-based clinical practice guidelines? Spine J.
https://www.ncbi.nlm.nih.gov/pubmed/28882524

Liu, L., Huang, Q.M., Liu, Q.G., Thitham, N., Li, L.H., Ma, Y.T., Zhao, J.M. (2017). Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated with Low Back  Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/28690077

Maher, C., Underwood, M., & Buchbinder, R. (2016). Non-specific low back pain. The Lancet.
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MacPherson, H., Vickers, A., Bland, M., Torgerson, D., Corbett, M., Spackman, E., ..., Watt, I. (2017). Acupuncture for chronic pain and depression in primary care: a programme of research. Southampton (UK): NIHR Journals Library.
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Müller-Schwefe, G., Morlion, B., ... Sichère, P. (2017). Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin.
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Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. Mayo Clinic Proceedings.
https://www.ncbi.nlm.nih.gov/pubmed/27594189

O'sullivan, P., Caneiro, J. P., O'keeffe, M., & O'sullivan, K. (2016). Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy.
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Puentedura, E.J., Flynn, T. (2016). Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature. Physiother Theory Pract.
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Qaseem, A., Wilt, T.J., McLean, R.M., Forciea, M.A. (2017). Clinical Guidelines Committee of the American College of Physicians.. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.
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Takamoto, K., Bito, I.,  Urakawa, S., Sakai, S., Kigawa, M., Ono, T., Nishijo, H. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain.
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Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., Macpherson, H., Foster, N. E., . . . Collaboration, F. T. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine.
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Vigotsky, A. D., & Bruhns, R. P. (2015). The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review. Pain Research and Treatment. 
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Wong, J., Côté, P., Sutton, D., Randhawa, K., Yu, H., Varatharajan, S., . . . Taylor-Vaisey, A. (2017). Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain.
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