health guides

Acupuncture may be helpful in the treatment of low back pain in some people. Case reports^{31, 32} and numerous preliminary trials^{33, 34, 35, 36, 37, 38, 39} have described significant improvement in both acute and chronic back pain following acupuncture (or acupuncture with electrical stimulation) treatment. In a single controlled study of acute back pain, both electroacupuncture and drug therapy (paracetamol) led to statistically significant pain reduction and improved mobility.⁴⁰

A few controlled clinical trials have evaluated acupuncture for chronic low back pain. A controlled trial found acupuncture was significantly superior to placebo (fake electrical stimulation through the skin) in four of five measures of pain and physical signs.⁴¹ Controlled trials using electroacupuncture have reported either benefit⁴² or no benefit⁴³ for chronic back pain. A double-blind trial compared acupuncture to injections of anaesthetic just below the skin at non-acupuncture points, and found no difference in effect between the two treatments.⁴⁴ Controlled trials have compared acupuncture to transcutaneous nerve stimulation (TENS). Some,^{45, 46} though not all,⁴⁷ demonstrated greater pain relief with acupuncture when compared to TENS, and one found improved spinal mobility only with acupuncture.⁴⁸

In one preliminary trial, acupuncture relieved pain and diminished disability in the low back during pregnancy better than physiotherapy.⁴⁹

A recent analysis and review of studies reported acupuncture was effective for low back pain,⁵⁰ though another recent review concluded acupuncture could not be recommended due to the poor quality of the research.⁵¹ A third review concluded that acupuncture was beneficial for people with slipped discs and sciatica and could be recommended at the very least as a supplementary therapy.⁵² Since the vast majority of controlled acupuncture research addresses chronic low back pain, it remains unknown whether people with acute low back pain benefit significantly from acupuncture.⁵³

The federally funded Agency for Health Care Policy and Research has deemed spinal manipulation effective for acute low back pain during the first month following injury.⁵⁴ This recommendation is supported by other research, though some has not been well controlled.^{55, 56} People whose initial pain or disability is severe to moderate appear to benefit the most, though those with longer lasting or chronic pain may also be helped by spinal manipulation.^{57, 58} One 12-month controlled study found no difference in benefit between manipulation and standard physical therapy.⁵⁹ Another controlled study found a series of eight treatments with spinal manipulation was as effective as conventional medical therapy, but the manipulation group needed less pain medication and physical therapy.⁶⁰ Practitioners who perform spinal manipulation include chiropractors, some osteopaths, and some physical therapists.

Some researchers suggest that spinal manipulation should not be performed on people with a herniated (slipped) disc, because it may lead to spinal cord injuries.⁶¹ However, other preliminary trials report that spinal manipulation helps those with herniated discs,^{62, 63, 64, 65} as did one controlled study comparing manipulation to standard physical therapy.⁶⁶ In one investigation of 59 people with slipped discs who received chiropractic treatment, including manipulation, 90% reported improvement.⁶⁷ Those with a history of low back surgery had poor outcomes. People with LBP due to herniated discs who wish to try this method should first consult with a chiropractor or other physician skilled in spinal manipulation. A recent controlled study compared manipulation, acupuncture, and medication for chronic spinal pain. Only manipulation significantly improved pain and disability scores.⁶⁸

There is inconclusive evidence that massage alone helps people with low back pain, though preliminary research indicates it has potential.⁶⁹ Many practitioners use massage in combination with other physical therapies, such as spinal manipulation or therapeutic exercise. People with low back pain who want to try massage should consult with a qualified massage therapist.

Some controlled trials indicate that biofeedback benefits people with chronic low back pain,^{70, 71} but other trials do not.^{72, 73} One study found that biofeedback was more effective than behavioural therapy or conservative medical treatment for people with chronic back pain. The study also found biofeedback to be the only method where people experienced significant reduction in pain for up to the two years of follow-up.⁷⁴ People wishing to try biofeedback should discuss this method with a qualified practitioner.

Emotional distress has been associated with aggravating low back pain,⁷⁵ including that caused by a herniated disc.⁷⁶ The effects on back pain of counselling aimed at reducing emotional stress remain unknown, though it is used in some clinics employing multidisciplinary approaches to treating chronic lower back pain.