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May 2011, Volume 41 Number 5 , p 54 - 55


  • Susan Simmons PhD, ARNP-BC


ABOUT 26% OF MEN and 30% of women experienced low-back pain in 2009.1 In 2007, the National Center for Complementary and Alternative Medicine (NCCAM) found that back pain was the most common pain syndrome for which patients sought complementary and alternative medicine (CAM) therapies.2This article discusses CAM therapies most commonly used for low-back pain-spinal manipulation, massage, and acupuncture-and the evidence supporting their use.The American College of Physicians (ACP) and the American Pain Society (APS) guidelines for the diagnosis and treatment of low-back pain state that spinal manipulation, massage, and acupuncture can be considered for patients with chronic or subacute pain.3 ACP and APS also recommended considering spinal manipulation for patients with acute low-back pain who didn't improve with self-care consisting of acetaminophen or nonsteroidal anti-inflammatory drugs, ice or heat, gentle stretching, and remaining active.3 The value of these CAM therapies for certain patients is supported by NCCAM research.2In one study, patients were randomized into CAM treatment or usual care for low-back pain.4 Those chosen for the CAM group were allowed to select spinal manipulation, massage therapy, or acupuncture. Researchers found that patient satisfaction increased when CAM treatments were used, but pain and function didn't improve significantly compared with usual care. The patients' out-of-pocket expenses were over $300 more with CAM than with usual care. Costs to insurance companies averaged almost $100 less because many CAM choices weren't covered.4A study released by NCCAM in 2010 revealed the following. * Acupuncture significantly reduced pain associated with chronic low-back pain, but the effect was greatest immediately after treatment. * Spinal manipulation significantly reduced acute low-back pain. * Massage reduced acute and subacute low-back pain but not chronic low-back pain.5This study also found that acupuncture could be a cost-effective,

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