Three Therapies for Aching Backs
H. L. Cunningham
If youve made it to adulthood and dont yet know what an
episode of back pain feels like, count yourself among the lucky.
Its estimated that 80 percent of adult Americans will suffer from a sore back at
some point in their lives, costing industry more than $50 million a year in absenteeism
and lost productivity.
To find relief, many sufferers
of chronic back pain are turning from conventional medicine to alternative options
so many that the alternatives are moving swiftly into the mainstream. And three treatments
once thought of as fringe chiropractic, acupuncture and yoga are slowly
amassing clinical evidence that, while not cures, they may provide at least some relief.
Chiropractors: Back Pain is Their
Dr. Jerome McAndrews, an osteopath and chiropractor who is national
spokesman for the American Chiropractic Association, says both back pain sufferers and
medical doctors are turning to chiropractic care in numbers unheard of not long ago.
"I attended a Harvard conference on alternative medicine four years ago," he
says, "and the medical doctors who were there wanted to learn when to refer to a
The moment demonstrated to him a meeting of the minds
that didn't exist a decade ago. "Chiropractic is becoming more a complementary
medicine than an alternative one," he says. The proof may be in the numbers.
Currently, chiropractors in the United States are treating 25
million patients, including 46 percent of all people injured in automobile accidents and
35 percent of those injured on the job.
The U.S. Department of Health and Human Services now
recommends chiropractic as an effective treatment for the management of low-back pain. And
two studies published in the New England Journal of Medicine suggest that
chiropractic treatment is as least as effective as more
conventional treatment when it comes to relief from pain. The first, published in 1995,
found treatment from chiropractors yielded about the same results as treatment from
primary care practitioners and orthopedic surgeons. The second, published in October 1998,
found patients reported less "bothersomeness" from their low back pain four
weeks after initial treatment by chiropractors when compared with treatment by physicians.
But by 12 weeks out, reports of pain from patients of chiropractors and M.D.'s were
comparable. It pays to remember that 80 percent of back pain
sufferers will be free of pain within six weeks and 90 percent will feel better within
three months, even if they do nothing at all.
Still, six weeks can be an eternity when they are
spent hunched in pain. Even Dr. Peter Slabaugh, an orthopedic surgeon and spokesman for
the American Academy of Orthopedic Surgeons, says chiropractors may have more success with
back pain patients than more conventional practioners. He says, "They have made back
pain their thing and put a lot of emotion into the patient interaction."
The "thing" that sets chiropractors apart is
their use of spinal adjustment. Chiropractors use precise and specific thrusts to correct
areas in the spine or joints that they determine are not moving correctly. By manipulating
these areas, which they call subluxations, chiropractors seek to restore normal motion to
the back and the nerves that control pain sensations and muscle movement.
Dr. McAndrews says back
pain is caused by these subluxations, initiated when one piece of the spine is injured and
the rest is left unbalanced and shifts and settles. He advocates a lifelong check-up
program beginning in infancy to prevent the back from compensating for these
injuries for too long.
Other experts in pain and back disorders say that
whether chiropractic will work may all be in the timing. Try it for two or three weeks, says Dr. Slabaugh, and if
it hasnt worked by then, it probably wont.
Dr. Art Brownstein, a clinical
instructor of medicine at the University of Hawaii at Manona and author of "Healing
Back Pain Naturally" (Harbor Press, 1999), also thinks short-term chiropractic care
is best. "I have seen people get in trouble with chiropractic," he says, voicing
a common complaint, "specifically, from chiropractors who have patients come back
(again and again), who get dependent and end up having manipulation when it is not
As might be expected, Dr.
McAndrews takes issue with this criticism, so much so that he wrote an article published
in the ACA Journal of Chiropractic defending his profession's liberal use of ongoing
visits. He says the length of treatment depends on how long the back has been distorted.
"If the initial injury happened 30 years ago," he insists, "you will need
to come back for repeated visits."
While she concedes chiropractic
might help in the first three months of chronic back pain, Dr. Margaret Caudill, creator
of the behavioral medicine pain program at Dartmouth-Hitchcock Clinics in Manchester,
N.Y., says the problem with ongoing visits is that they can become a crutch. "When
you get to years and years after an injury, pain sufferers need to focus on
self-management and making themselves better rather than relying on a chiropractic. It
takes their control away."
Acupuncture: Balancing the Flow
More than a million Americans each year seek relief from all kinds
of pain with acupuncture, which consists of inserting needles into precise points in the
body for 20 to 40 minutes at a time. Acupuncture has been used to counteract pain in China
for more than 3,000 years. It works, practitioners say, by balancing the body's energy
flow, called qi or chi.
In November 1997, the National
Institute of Health's Office of Alternative Medicine issued a statement supporting the use
of acupuncture as an effective adjunct therapy for back pain. And new research indicates
the metaphysical concept of acupuncture also has a traditionally scientific basis.
Songping Han, a researcher at the St. Louis University
School of Medicine and author of a study on the scientific basis for acupuncture published
last year in the Southern Medical Journal, says the pain
relief acupuncture provides is due to neuroelectric stimulation, not chi. Acupuncture stimulates nerve endings that transmit signals
to the brain, activating the pain control center in the body and triggering the release of
endorphins, says Han.
Furthermore, Han says those
suffering from back pain don't necessarily need to be treated with needles to find relief,
unless affected nerve endings are very deep. He says research suggests the use of
electrical stimulation at the determined points is highly effective, and even the use of
pressure or heat on these particular areas can relieve pain.
Pain experts say if you are
struggling with back pain, acupuncture probably can't hurt and it seems to work for
some, whether the reason for success is stimulated nerve endings or unblocked chi. "I
take a pragmatic approach, start with the treatment that offers the least risk, and build
up if needed," says Kenneth Lafland, head psychologist and director of the Pain and
Rehabilitation Clinic of Chicago.
Yoga: Listen to the Body
Back pain sufferers know that the pain demands full attention.
According to Judith Lasater, author of "Relax and Renew: Restful Yoga for Stressful
Times" (Rodmell Press, 1995) it's important to slow down and listen to the painful
messages the body is sending in order to find relief.
Lasater, a physical therapist
who holds a doctorate in east-west psychology, teaches yoga classes and trains yoga
teachers. "Yoga can help those with back pain by helping them be aware of the ways
they are contributing to their own muscular-skeletal strain," she says.
"The body is always giving us cues and we don't
listen. If it says it is tired we drink more coffee. If it says it is hungry, we say not
now. Pain is the body's way of getting attention and should not be ignored."
Yoga, Lasater says,
allows those with back pain to pinpoint the places theyre holding tension and
relaxes them enough that they are able to let it go.