Low Back Pain and CAM
Low-Back Pain and Complimentary and Alternative Medicine (CAM)
Four out of five American adults will experience low-back pain (LBP) at some time in their lives. If you are a health care provider, you have almost certainly cared for such patients. No doubt, some of them have asked you about using complementary and alternative medicine (CAM) to relieve their pain. This article provides an overview of the use of CAM therapies for LBP and lists evidence-based sources for additional information. A Challenging Condition
LBP is a major public health burden in the United States. It is the leading cause of work-related disability and missed days of work, and the fifth-most-common reason for physician visits. A 2006 report estimated that annual costs of LBP in this country exceed $100 billion. Two-thirds of that is for indirect costs, such as lost wages and reduced productivity.
Seeking Options in CAM
"Low-back pain is one of our society's most common, burdensome health problems," says Josephine P. Briggs, M.D., Director of NCCAM. "The currently available treatments have limitations. Many patients turn to CAM with the hope of decreasing pain, improving function and quality-of-life, preventing recurrence and chronicity, or avoiding side effects of other treatments."
According to the 2007 National Health Interview Survey, back pain is the most common condition for which American adults use CAM. Data suggest that the CAM therapies most frequently used for LBP are chiropractic/manipulation, massage, and acupuncture. Other CAM approaches include yoga, herbal and other dietary supplements, devices, and lifestyle products.
Evaluating Treatment Options
Identifying optimal treatment approaches for LBP can be difficult for both patients and clinicians. A thorough patient assessment is the first step for a clinician who may be considering recommending CAM therapies. Clinical practice guidelines stress the importance of ruling out serious underlying conditions and evaluating a patient's psychosocial factors and emotional distress when doing an assessment of LBP.
Among recent recommendations on LBP are joint clinical guidelines from the American College of Physicians and the American Pain Society (ACP/APS). Released in 2007, the statement's seven major recommendations to clinicians include:
Findings on CAM from Systematic Reviews Systematic reviews on CAM for LBP may be divided into two categories: Cochrane Systematic Reviews. The Cochrane Collaboration is an international nonprofit organization of health care professionals. Its authors use a systematic process to analyze the results of clinical trials and other sources to explore the evidence for and against the effectiveness and appropriateness of health care treatments. Topics pertaining to CAM for LBP include: Findings on CAM from Systematic Reviews Systematic reviews on CAM for LBP may be divided into two categories: Cochrane Systematic Reviews. The Cochrane Collaboration is an international nonprofit organization of health care professionals. Its authors use a systematic process to analyze the results of clinical trials and other sources to explore the evidence for and against the effectiveness and appropriateness of health care treatments. Topics pertaining to CAM for LBP include: Massage Herbal medicine Spinal manipulative therapy Acupuncture Chiropractic interventions Behavioral treatments (including some mind-body therapies). Other Systematic Reviews: The CAM on PubMed database, a service of NCCAM and the National Library of Medicine, provides abstracts of systematic reviews published in peer-reviewed medical and scientific journals. Examples of relevant review topics include: Spinal manipulation and mobilization Osteopathic manipulative treatment Acupuncture Herbal and other dietary supplements Willow bark Devil's claw Spa therapy and balneotherapy (treatment based on bathing in water). Two of the themes that are consistent throughout the body of systematic reviews on CAM for LBP are that the evidence evaluated is limited—for example, in its quantity or quality—and that more high-quality research is needed. Specific areas for future research in CAM for LBP include the cost-effectiveness of CAM therapies; head-to-head comparisons of therapies and studies of the effectiveness of CAM therapies versus usual care; and the optimal form, duration, and frequency for treatments. Specific areas for future research in CAM for LBP include the cost-effectiveness of CAM therapies; head-to-head comparisons of therapies and studies of the effectiveness of CAM therapies versus usual care; and the optimal form, duration, and frequency for treatments.NIH March, 2009 newsletter
1. Ask your patients about CAM. Research has found that most patients do not disclose CAM use to their health care providers. Let them know they can discuss any therapy with you that they are interested in or are using. 2. Evidence-based information for you and your patient is available from NCCAM as well as other resources listed below. Visit the NCCAM Web site for additional links. 3. When making referrals to other practitioners, find out about their training, and their licensing or certification, if applicable. Ask specifically about the nature and length of their experience in treating LBP. Health care providers of all types may be involved in the care of patients with LBP. Open and clear communication between providers helps ensure coordinated and safe care. "There is much more to learn about the effectiveness and safety of CAM therapies for chronic LBP and other chronic pain conditions," says Dr. Briggs. "Building a better and clearer evidence base in these areas, and sharing reliable information, are priorities for NCCAM." Back pain and CAM is one of many entries. You can learn much, much more!
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