An Integrative Approach to Low Back Pain

In Dr. Nicole Cotter, Health and Beauty by Lola Magazine

Whether or not you keep up with the news, you have no doubt heard about the opioid crisis in America. What started as the compassionate development of pharmaceuticals for management of pain has turned into a firestorm of prescription and addiction. In response to the opioid crisis, physicians, institutions, and the government are looking for ways to reduce the use of and demand for opioid medications. One of the more common medical problems for which opioids are prescribed is low back pain. This also happens to be THE most common reason that Americans seek out complementary and alternative medicine.

In April 2017, the American College of Physicians published guidelines for the noninvasive treatment of back pain, stating that clinicians should only consider opioids for low back pain when other specified treatments have failed. In addition, these guidelines highlight complementary and alternative modalities for management of low back pain, recognizing how these practices have a prominent role in the treatment of this common medical problem.

If you have experienced low back pain, you are not alone. Most people will experience low back pain at some point in their lives. The majority recover quickly and are back to their usual activities within a month. For a much smaller percentage, the back pain becomes chronic, persisting after three months.

The reasons why people develop back pain are many and range from harmless to emergent. The majority of low back pain, however, appears to be nonspecific. In medical school, we learn about “red flags,” those symptoms which cause concern when associated with low back pain and warrant immediate evaluation, including fever, weight loss, numbness around the buttocks and incontinence.

It is always a good idea to see your doctor for evaluation, but identifying the exact cause of low back pain is not always possible. Imaging, such as X-rays and MRIs, has limits and may not add useful information. A history and physical exam are usually enough to determine a treatment plan.

There are many useful nonpharmacologic treatments for chronic low back pain. In my opinion, an integrative approach is best. The solution is likely not one specific thing but rather integration of many modalities that get you well.

We know that nutrition can influence pain. In addition to improving mood and energy, certain foods have anti-inflammatory properties that can directly or indirectly affect pain. Following an anti-inflammatory diet is important.

Although one type has not been shown superior, exercise is a proven treatment for chronic low back pain. A physical therapist can help guide you with exercise therapy if needed. Tai Chi, a Chinese martial art and graceful form of exercise, has been shown to improve chronic low back pain. Yoga is another form of movement with evidence for its use in the management of chronic low back pain. Although considered a form of exercise by many, yoga has other components, such as breathing and meditation, that have also proven beneficial for chronic low back pain.

On that note, mind body medicine should have a place in any treatment plan for chronic low back pain. Our nervous systems adapt and change when faced with chronic pain, so it makes sense to incorporate mind-body interventions that address this. Meditation, relaxation, biofeedback, and cognitive behavioral therapy are examples of mind-body interventions with data showing benefit for the management of chronic low back pain. Mindfulness-based stress reduction has shown great promise in this area. Massage, particularly when used in combination with other modalities, is beneficial for low back pain. Acupuncture, a component of traditional Chinese medicine and commonly used for the treatment of pain, can be useful as well. This is certainly not a complete list of complementary and alternative modalities that are beneficial for chronic low back pain, but it should illustrate the diverse availability of options to integrate.

There are supplements and botanicals that can be helpful for the management of low back pain. Devil’s Claw is a herb native to Africa that has long been used for treatment of pain. Strong evidence exists for its effectiveness in low back pain, in particular. Willow is the herb that gave rise to aspirin. It, too, can be useful for low back pain, but because it has similar components to aspirin its precautions are similar. As with the initiation of any supplements, you should first discuss these with your doctor to avoid drug-herb interactions and ensure their appropriateness.

Why certain people develop chronic symptoms of low back pain is not completely understood. We know that someone who is anxious or depressed is more likely to have chronic low back pain. A negative attitude also makes it more likely that back pain will persist. Maintain a healthy weight and stay physically active. Manage stress and incorporate relaxation into your daily routine. Practice positivity. If you find yourself with persistent low back pain, see your doctor and discuss an integrative approach with the initial focus on nonpharmacologic measures. This is certainly one area of medicine that has caught on to the benefits of integrative medicine.
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)