Patients commonly use nonpharmacologic treatment options, with or without consulting a physician. Forty-five percent of patients with low back pain see a chiropractor, 24 percent use massage, 11 percent get acupuncture, and 7 percent try meditation.
Acupuncture provides short-term relief of chronic low back pain, improves functioning, and works as an adjunct to other therapeutic options. It has not been shown to be more effective than other treatments. Fifty-one to 64 percent of patients are willing to try acupuncture if recommended by their physician.
Exercise therapy, focusing on strengthening and stabilizing the core muscle groups of the abdomen and back, appears to produce small improvements in pain and functioning in patients with chronic low back pain. However, few studies (i.e., six of the 43 studies included in a Cochrane review) have been able to demonstrate clinically important and statistically significant differences between intervention and control groups.
Behavior therapy is as effective as exercise therapy for short-term relief of chronic low back pain. Consistent evidence supports cognitive behavior therapy and progressive relaxation for short-term improvement, whereas biofeedback techniques have produced mixed results. Combining behavior therapy with other modalities does not have an additive effect.
Multidisciplinary rehabilitation programs that include a physician and at least one additional intervention (psychological, social, or vocational) alleviate subjective disability, reduce pain, return persons to work five weeks earlier, and after returning to work, reduce the amount of sick time in the first year by seven days. Benefits persist for up to five years.
Acupuncture massage and pressure point massage are mildly helpful for reducing chronic low back pain, and the benefits last for up to one year. Massage appears to be most effective when combined with exercise, stretching, and education.
Spinal manipulation provides modest short- and long-term relief of back pain, improves psychological well-being, and increases functioning.The benefits derived are not dependent on the type of training of the manipulator because osteopathic and chiropractic outcomes appear to be similar.
One therapeutically directed style of yoga (Viniyoga) may provide some relief of chronic back pain. Six weeks of yoga decreased medication use and provided more pain relief than exercise and self-care. Other forms of yoga have mixed results in small studies, and at this time there is not enough evidence to recommend them.
Back schools, low-level laser therapy, lumbar supports, prolotherapy, short wave diathermy, traction, transcutaneous electrical nerve stimulation, and ultrasound have negative or conflicting evidence of effectiveness
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