Podcast: Complementary Medicine for Low Back Pain: Who, What, and How

In most cases of low back pain, surgery is not a helpful intervention, according to the best evidence. Appropriate use of painkillers is a complicated issue. For this difficult problem, alternative therapies such as massage and spinal manipulation may be an attractive option.

For guidance on when and how to consider integrative approaches to low back pain, ConsultantLive turned to Wolf Mehling, MD, an associate professor of family medicine at the University of California San Francisco.

Questions:

Isn't it likely that a patient with lower back pain has already tried an alternative or complementary approach before contacting the primary care doctor about it?

Among the various integrative therapy options for this condition, which ones have been shown the most effective in the clinical literature?

Who is most likely to benefit from this kind of integrative therapy?"

If you had a patient who has already tried massage or yoga or any of these treatments and it just isn't helping, would you recommend trying a different integrative approach or moving on to some other more standard medical option?

Do you have any guidance for doctors about when it's time to move on from any one of these approaches? How long should they be tried before deciding that they don't work?

Do you have any advice on identifying good providers in a physician's community?

Key Quotations:

"Several studies showed that expectations play a role, so if a patient has some hope in some of these approaches, some preferences ... that's some cause to be supportive... If a patient has some expectations, then that method would probably work better."

"For spinal manipulation, specifically, ... [with] acute pain of less than 16 days, it's better if they don't have severe hip osteoarthritis and if they have a low degree of fear of pain, fear avoidance, those patients would benefit more from spinal manipulation than others." 

Complementary Medicine for Low Back Pain: Who, What, and How

 For your reference:

National Certification Commission for Acupuncture and Oriental Medicine
"Find a Certified Practitioner" Directory

American Massage Therapy Association
"Find a Massage Therapist" Directory