NIH Endorses Alternative Therapies for Back Pain

In the midst of the debate on healthcare, it may be interesting to note to what extent the Federal government is changing its bureaucratic mindset about what is good medicine and healthcare. The evidence: The National Institute of Health's National Center for Complementary and Alternative Medicine.

The government does fund and conduct research on what it calls evidence-based complementary therapies. Its goal is to separate the wheat from the chaff and to determine what really works and what doesn’t. For example, in a November 2009 commentary, the new director of the Center, Dr. Josephine P. Briggs, discusses complementary medical therapies for back pain.

At first, it may appear odd that the director of the National Center for Complimentary and Alternative Medicine’s first message is about back pain. But back pain is one of the most common medical complaints in the American population. According to Forbes, Americans visit their doctor 12.6 million times a year to complain about their backs.

Lower Back Pain is a major public health burden in the United States. It is the fifth-most-common reason for physician visits. A 2006 report estimated that annual costs of Lower Back Pain in this country exceed $100 billion. Two-thirds of that is for indirect costs, such as lost wages and reduced productivity. As the leading cause of work-related disability and missed days of work, it has a significant impact on business efficiency and economic output.

There is a wide variety though how back pain is described in the literature. Lower Back Pain is often classified either as acute (pain that lasts up to 4 weeks); subacute (pain lasting from 4 to 12 weeks); or chronic (pain lasting for 3 months or longer).

The NCCAM acknowledges that there is a range of non-pharmacological and non-surgical treatments that have stood the scrutiny of scientific study and have demonstrated various levels of success.  In 2007 the American College of Physicians and the American Pain Society (ACP/APS) issued a joint clinical guideline on the diagnosis and treatment of low back pain. This guideline was the culmination of a careful systematic review of the literature.

For acute low back pain, the guidelines point to chiropractic care such as spinal manipulation. The study concluded that while spinal manipulation did work, its efficacy had small-to-moderate, short-term benefit. For chronic low back pain, the guidelines listed a number of therapies that demonstrated fair-to-good supporting evidence for moderate effectiveness. These modalities included acupuncture, massage therapy, progressive relaxation, and Viniyoga-style yoga.

The National Center for Complementary and Alternative Medicine plans to continue to invest in back pain research. As one of the co-chairs for the NIH Pain Consortium (a trans-NIH effort to further develop a forward-thinking pain research agenda), the group is enthusiastically pursuing opportunities for cross-NIH collaboration. As NCCAM moves forward, I am hopeful that our rigorous research on CAM therapies for back pain will offer additional treatment options and assist everyone with an aching back to make informed health care decisions.



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