Five proven natural therapies for relieving chronic low back pain

38% of the worldwide population experiencing low back pain condition in a year

Low back pain (LBP) is a common health problem with an estimated 38% of the worldwide population experiencing this condition in a year [1]. Although some instances of LBP can be caused by injury/fracture, infection, tumour, arthritis, or osteoporosis, most of them are non-specific, that is, the pain cannot be attributed to any definite cause [2].

LBP is commonly treated with medications such as painkillers (acetaminophen/Panadol or nonsteroidal anti-inflammatory drugs) and muscle relaxants, as well as exercises by physiotherapists [2]. While many non-specific LBP cases can be resolved quickly, about 5-10% will become chronic LBP (CLBP) lasting for 12 weeks and more [3], which can cause severe stress, escalating treatment cost and disability.  CLBP is especially common amongst older adults age 65 and above, causing both physical pain, psychological disturbances, loss of function, and degrading the quality of life [4].

Painkillers can only be a short-term solution, but not a long-term cure for CLBP

The sad fact is that pain medications can only provide temporary relief to CLBP. To recover from this rehabilitating condition, one should explore treatment beyond medications. Here are five natural therapies that have been proven by rigorous scientific studies to offer pain relief and functional improvement for CLBP.

Exercise

Most people with CLBP tends to become less active due to the pain. However, the last thing one with CLBP should do is bed rest. In fact, there is evidence showing that prolonged bed rest may worsen the condition [5]. On the contrary, exercise is highly recommended. Many high-quality randomised controlled studies have consistently found exercise to be significantly effective in reducing pain and disability, compared to no exercise [6].

Core strengthening exercise improves flexibility and function

Resistance (strength) training and lumbar/core strengthening are two types of exercise most suitable for persons with CLBP [7]. Resistance training using weights to strengthen the muscles as well as enhance the integrity of connective tissues within the muscles, joints, and bone mineral density [7]. Lumbar/core strengthening exercise focuses on strengthening the group of muscles that work together to produce maximum stability in the abdominal and lumbar (lower) back region. The same group of muscles also coordinates the movement of the arms, legs, and spine. By improving the control, strength, and stability of these muscles, persons with CLBP can hope to return to normal activities in daily life [8].

Yoga

Yoga has also been found to be effective in relieving pain and improving function for CLBP. It can also potentially help to improve the psychological symptoms such as anxiety and depression [8]. Modern yoga practices usually combine elements of postural positioning, breathing, concentration, and meditation that is guided by an instructor. Compared to gym exercise, many find yoga to be more easily remembered and relaxing, with the added benefits of spiritual and psychological harmony, for treating CLBP.

Yoga combines elements of postural positioning, breathing, concentration, and meditation.

Tai-chi

Tai-chi is considered as a mind-body exercise therapy that is useful for the management of chronic pain conditions, including CLBP. The slow-moving and weight shifting during tai-chi exercise can help to improve muscle and skeletal strength as well as joint stability. Applying concentration and mindfulness in tai-chi may help to modulate mood, immune function and autonomic nervous systems [9]. Practising tai-chi in 18 40-minute group sessions over a 10-week period has been shown to be effective in reducing pain intensity and bothersomeness of back symptoms, as well as self-reported disability scores, according to a randomized controlled trial (RCT) conducted in Sydney, Australia with 160 CLBP participants [10].

Tai-chi exercise can help to improve muscle and skeletal strength as well as joint stability

Massage

For those who are not keen to do exercise, massage therapy can be an alternative treatment for CLBP. Massage is defined as a patterned and purposeful manipulation of soft-tissue for therapeutic purposes. Almost all cultures have developed some form of traditional massage for healing and well-being [11]. The effect of massage therapy on CLBP has been studied extensively. The latest Cochrane review, which includes 25 RCTs with 3096 participants, finds massage therapy to be better than inactive controls (sham therapy, no treatment, waiting list controls, or usual care) in treating CLBP, for pain reduction and functional improvement, in the short-term (12 – 26 weeks) [12]. However, the effect may likely to diminish over time. Many forms of massage have been shown to be effective: relaxation, structural, Thai, Chinese tuina, and pressure point [12]. Indeed, it is a good idea to go for massage sessions regularly for CLBP treatment.

Massage therapy helps to reduce pain and improve function in CLBP

Acupuncture

In traditional Chinese medicine, acupuncture is frequently used to treat LBP. Based on the theory of meridian and balancing of yin and yang, this traditional form of therapy has been used to treat pain for over thousands of years [13]. Like massage therapy, the effects of acupuncture for CLBP has been studied extensively over the years. No less than 16 systematic reviews of RCTs were published in scientific journals. It has been consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement among CLBP patients compared with no treatment, sham treatment, or usual care [14]. The effect of acupuncture on pain is thought to come from stimulating the central nervous system to trigger the release of neurochemicals that promote natural pain relief and a sense of well-being. However, the actual physiological is still unknown[15].

Acupuncture stimulates the release of neurochemicals that promote pain relief

Conclusion

CLBP is a debilitating condition. Pain medications provide only temporary relief but not lasting peace. Many complementary and alternative therapies, including exercise, yoga, tai-chi, massage, and acupuncture, have been shown to be able to relieve pain and improve function. For individuals with CLBP, it is worth exploring these natural therapies to manage the pain and improve well-being.

References

[1]        L. Manchikanti, V. Singh, F.J.E. Falco, R.M. Benyamin, J.A. Hirsch, Epidemiology of low back pain in Adults, Neuromodulation. 17 (2014) 3–10. doi:10.1111/ner.12018.

[2]        B. Casazza, Diagnosis and treatment of acute low back pain, Am Fam Physician. 85 (2012) 343–350. doi:d10227 [pii].

[3]        R.D. Meucci, A.G. Fassa, N.M. Xavier Faria, Prevalence of chronic low back pain: Systematic review, Rev. Saude Publica. 49 (2015) 1–10. doi:10.1590/S0034-8910.2015049005874.

[4]        A.Y. Wong, J. Karppinen, D. Samartzis, Low back pain in older adults: risk factors, management options and future directions, Scoliosis Spinal Disord. 12 (2017) 14. doi:10.1186/s13013-017-0121-3.

[5]        M.S. Wilkes, Chronic back pain: does bed rest help?, West. J. Med. 172 (2000) 121. http://www.ncbi.nlm.nih.gov/pubmed/10693375 (accessed January 12, 2018).

[6]        M. van Middelkoop, S.M. Rubinstein, A.P. Verhagen, R.W. Ostelo, B.W. Koes, M.W. van Tulder, Exercise therapy for chronic nonspecific low-back pain., Best Pract. Res. Clin. Rheumatol. 24 (2010) 193–204. doi:10.1016/j.berh.2010.01.002.

[7]        T.E. Dreisinger, Exercise in the management of chronic back pain., Ochsner J. 14 (2014) 101–7. http://www.ncbi.nlm.nih.gov/pubmed/24688341 (accessed January 12, 2018).

[8]        W.-D. Chang, H.-Y. Lin, P.-T. Lai, Core strength training for patients with chronic low back pain., J. Phys. Ther. Sci. 27 (2015) 619–22. doi:10.1589/jpts.27.619.

[9]        L.J. Kong, R. Lauche, P. Klose, J.H. Bu, X.C. Yang, C.Q. Guo, G. Dobos, Y.W. Cheng, Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials., Sci. Rep. 6 (2016) 25325. doi:10.1038/srep25325.

[10]      A.M. Hall, C.G. Maher, P. Lam, M. Ferreira, J. Latimer, Tai chi exercise for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial, Arthritis Care Res. (Hoboken). 63 (2011) 1576–1583. doi:10.1002/acr.20594.

[11]      R.N. Calvert, The History of Massage: An Illustrated Survey From Around The World, Healing Arts Press, Rochester, Vermont, 2002.

[12]      A.D. Furlan, M. Giraldo, A. Baskwill, E. Irvin, M. Imamura, Massage for low-back pain, Cochrane Database Syst. Rev. (2015) Art. No.: CD001929. doi:10.1002/14651858.CD001929.pub3.

[13]      Q. Yuan, T. Guo, L. Liu, F. Sun, Y. Zhang, Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis., PLoS One. 10 (2015) e0117146. doi:10.1371/journal.pone.0117146.

[14]      L. Liu, M. Skinner, S. McDonough, L. Mabire, G.D. Baxter, Acupuncture for low back pain: an overview of systematic reviews., Evid. Based. Complement. Alternat. Med. 2015 (2015) 328196. doi:10.1155/2015/328196.

[15]      H.H. Moffet, How might acupuncture work? A systematic review of physiologic rationales from clinical trials., BMC Complement. Altern. Med. 6 (2006) 25. doi:10.1186/1472-6882-6-25.

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