Back Pain
8 out of 10 people experience back pain at some time in their lives making it one of the most common medical concerns.[1] Most episodes of back pain spontaneously resolve usually in a couple of weeks. [2] Analgesics and rest may help while too much staying in bed may just worsen the scenario. [1]Persistent and severe back pain warrants the need for medical attention especially when back pain occurs following an injury.
There are many causes of back pain though in a number of individuals, no definite cause can be found. Back pain commonly occurs due to strained muscles and ligaments. It may result from improper lifting of objects, particularly heavy items.[2]
Structural problems may be another cause of back pain. These are ruptured or bulging vertebral discs, sciatica, arthritis, skeletal irregularities and osteoporosis. [3] Though many people with bulging discs do not experience back pain, some may exhibit the symptom with pain that is aggravated with coughing or forward bending at the waist.[4] If there is nerve impingement, the patient may suffer fromsciatica. This is manifested as a sharp, shooting pain that extends downward towards the buttocks and the back of the leg.[3] When back pain is experienced with movement, the person might actually have lumbar spine arthritis which involves the joints of the spine. Back pain due to osteoporosis is usually related tocompression fractures of the spine when the bones have become brittle.[2]
Back pain may also be experienced in caudaquina syndrome, spondylitis and infection. Cauda equina syndrome requires urgent attention. Spinal cord is directly compressed which results in loss ofbowel and urinary bladder control. Sensation may also be absent. Spondylitis or noninfectious spinal inflammation causes rigidity which is worse in the morning. [5] Infection is possible when the back pain is accompanied by fever, pain during urination and foul-smelling urine. [4] A tumor which directly presses on the spine is another source of back pain.
Thorough medical history and physical examinations are done to determine the cause of back pain. When a specific condition is suspected, the physician may order blood and urine tests, X-ray, MRI, bone scan or nerve studies. [3] Treatment of back pain can range from simple home self-care such as rest, exercise and pain relievers to as complex as spine surgery.[2]
Condition References
Efficacy of Alternative and Other Treatments According to GRADE* Ranking
Turmeric [1, 26, 27, 28, 29, 30, 31]
Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (There is insufficient evidence to support claims that turmeric can help in the treatment of pain. More research is needed.)
Grade of Evidence: Very Low quality of evidence
Thuja (Eastern White Cedar, Thuja occidentalis) [1, 23, 24, 25]
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Little is known about the full effects of Thuja, so it is not recommended for medicinal use. Thuja can be poisonous if ingested in large amounts.
Recommendation: No recommendation (There is insufficient evidence to support claims that Thuja helps to treat back pain)
Grade of Evidence: Very Low quality of evidence
Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 20, 21, 22]
WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested.
Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)
Grade of Evidence: Very Low quality of evidence
Six Flavor Tea (Liu Wei Di Huang Wan, Rehmannia Six) [1, 18, 19]
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (There is insufficient evidence to show that Six Flavor Tea helps in any way in the treatment of back pain)
Grade of Evidence: Very Low quality of evidence
Pau D'Arco (Lapachol, Tabebuia impetiginosa, Tabebuia heptaphylla) [1, 17]
Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.
Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'Arco helps to treat back pain. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)
Grade of Evidence: Very Low quality of evidence
Cannabis (Marijuana, weed, hemp) [1, 8, 9, 10, 11, 12, 13, 14, 15, 16]
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor (Evidence shows that smoking or ingesting cannabis may help in relieving symptoms of pain, although some studies have yielded mixed results)
Grade of Evidence: Low quality of evidence
Comfrey (Blackwort, Symphytum officinale) [1, 5, 6, 7]
Please note, this herb is TOXIC IF TAKEN ORALLY, OR IF APPLIED TO AN OPEN WOUND. Can cause severe liver or kidney damage and lead to death. May ONLY be used as a cream over intact skin, and does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor (ONLY TO BE USED AS A CREAM OVER HEALTHY SKIN. Studies have shown that if applied over intact skin, creams with Comfrey extracts can help to treat the symptoms of back pain)
Grade of Evidence: Low quality of evidence
Chaparral (Larrea tridentata Coville) [1, 2, 3, 4]
Please note, this herb is HIGHLY TOXIC, and has been reported to cause severe and permanent liver disease which can be fatal.
Recommendation: Strongly against (Existing evidence shows that Chaparral is not an effective treatment for back pain. In addition, this herb is highly toxic and potentially life threatening.)
Grade of Evidence: Low quality of evidence
Black Cohosh (Cimicifuga racemosa)
Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.
Grade of Grade of Evidence: Moderate quality of evidence
Recommendation: No recommendation (Available evidence does not support claims that Black Cohosh helps to treat symptoms of back pain in any way. Studies have yielded mixed results)
Transcutaneous Electrical Neuromuscular Stimulation
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (There is not enough evidence supporting the role of TENS in pain therapy)
Grade of Evidence: Low quality of evidence
Therapeutic Touch
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor (A reliable study demonstrated that this form of therapy helps reduce some types of pain, but more studies are needed)
Grade of Evidence: Low quality of evidence
Reiki
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor (some studies show that Reiki may help reduce pain among some patients, but this had no effect on the amount of pain medication they needed to take later)
Grade of Evidence: Very Low quality of evidence
Reflexology
Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: Weakly in favor (A controlled study showed that Reflexology may help some people with pain for a maximum of three hours, but shows no effect after that)
Grade of Evidence: Low quality of evidence
Polarity Therapy
Please note, this management does NOT treat the condition itself. It may mildly help with the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (available research does not show that Polarity Therapy might help reduce pain)
Grade of Evidence: Low quality of evidence
Osteopathy
Please note, this management does NOT treat the condition itself. It may mildly help with the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (Available scientific evidence does not support Osteopathy as helpful alone in pain)
Grade of Evidence: Low quality of evidence
Neural Therapy
Please note, this management does NOT treat the condition itself. It may mildly help with the symptoms, and even then has insufficient evidence to back up this claim at present.
Recommendation: No recommendation (no reliable clinical studies have been done to support neural therapy's role in reducing pain)
Grade of Evidence: Very Low quality of evidence
Massage
Recommendation: Strongly in favor (Some studies have shown that massage therapy can help decrease pain)
Grade of Evidence: Low quality of evidence
Low-Level Laser Therapy
Recommendation: No recommendation (There have been ambiguous results on the few studies done investigating the effect of laser therapy on pain)
Grade of Evidence: Very Low quality of evidence
Acupuncture
Recommendation: Weakly in favor (There is some evidence that suggest that Acupuncture may decrease the need for pain medication)
Grade of Evidence: Low quality of evidence
Qigong
Recommendation: Weakly in favor (One published study found that Qigong may help in reduction of pain)
Grade of Evidence: Low quality of evidence
Aromatherapy
Recommendation: Weakly in favor (early trials suggest that aromatherapy helps patients cope with pain)
Grade of Evidence: Low quality of evidence
Creative Art Therapy (Expressive Therapy)
Recommendation: No recommendation (there is no reliable evidence suggesting that creative arts therapy may help manage pain)
Grade of Evidence: Very Low quality of evidence
Ayurvedic Medicine (Ayurveda)
Recommendation: No recommendation (there is insufficient evidence that suggests that Ayurvedic Medicine may help manage pain)
Grade of Evidence: Very Low quality of evidence
Curanderismo
Recommendation: No recommendation (although there are reports from people that Curanderismo may help deal with pain, but there are no reliable studies done yet)
Grade of Evidence: Very Low quality of evidence
Humor Therapy
Recommendation: Weakly in favor (One study has shown that humor therapy may help increase pain tolerance)
Grade of Evidence: Very Low quality of evidence
Hypnosis
Recommendation: Weakly in favor (There are many reports that demonstrate that hypnosis helps patients better manage and reduce pain)
Grade of Evidence: Low quality of evidence
Image Therapy
Recommendation: Weakly in favor (a review of a number of studies conducted showed that Image Therapy may be helpful in reducing pain)
Grade of Evidence: Low quality of evidence
Meditation
Recommendation: Weakly in favor (clinical trials have shown that meditation can help reduce pain)
Grade of Evidence: Low quality of evidence
Music Therapy
Recommendation: Weakly in favor (Music therapy has been shown to be effective for short-term management of pain)
Grade of Evidence: Low quality of evidence
Native American Healing
Recommendation: No recommendation (No reliable studies have shown that Native American Healing may help deal with pain)
Grade of Evidence: Very Low quality of evidence
Naturopathic Medicine
Recommendation: No recommendation (No reliable studies have shown that Naturopathic Medicine may help to deal with pain)
Grade of Evidence: Very Low quality of evidence
Magnetic Therapy
Recommendation: No recommendation (Clinical trials regarding Magnetic Therapy treating back pain have yielded mixed results)
Grade of Evidence: Low quality of evidence
Craniosacral Therapy
Recommendation: No recommendation (Clinical trials have not shown that Craniosacral therapy can help treat back pain)
Grade of Evidence: Low quality of evidence
Chiropractic
Grade of Grade of Evidence: Moderate quality of evidence
Recommendation: Strongly in favor (many studies have shown that Chiropractic is effective in treating back pain)
Devil's Claw [32, 33, 34, 35, 36]
Recommendation: Weakly in favor (may have side effects)
Grade of Grade of Evidence: Moderate quality of evidence
* GRADE Working Group: www.gradeworkinggroup.org
Summary References
Treatments:
- Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complementary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009
- http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2005/2005_135-eng.php
- Edible and Medicinal Plants of the West, Gregory L. Tilford, ISBN 0-87842-359-1
- http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=chaparral&x=0&y=0
- http://www.ncbi.nlm.nih.gov/pubmed/19460762
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/comfrey
- http://www.ncbi.nlm.nih.gov/pubmed/2103401
- http://www.nlm.nih.gov/medlineplus/marijuana.html
- http://nccam.nih.gov/research/extramural/awards/2004/
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/marijuana
- http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/complementary--alternative-medicine/marijuana/index.aspx
- http://www.ncbi.nlm.nih.gov/pubmed/16957511
- http://www.ncbi.nlm.nih.gov/pubmed/12965981
- http://www.ncbi.nlm.nih.gov/pubmed/17589370
- http://mct.aacrjournals.org/content/6/11/2921.long
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562334/?tool=pmcentrez
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/pau-d-arco
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/six-flavor-tea
- Shen JJ, Lin CJ, Huang JL, Hsieh KH, Kuo ML. The effect of liu-wei-di-huang wan on cytokine gene expression from human peripheral blood lymphocytes. Am J Chin Med. 2003;31(2):247-57.
- David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5
- Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica
- http://www.nlm.nih.gov/medlineplus/ency/article/002769.htm
- http://plants.usda.gov/plantguide/pdf/cs_thoc2.pdf
- http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=thuja&x=0&y=0
- http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/turmeric
- http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-turmeric.html
- http://nccam.nih.gov/health/turmeric/index.htm
- http://news.bbc.co.uk/2/hi/health/1668932.stm
- http://www.mirror.co.uk/news/top-stories/2009/10/28/curry-kills-cancer-cells-and-other-health-benefits-of-the-nations-favourite-dish-115875-21779950/
- http://clinicaltrials.gov/ct2/results?term=turmeric
- http://www.ncbi.nlm.nih.gov/pubmed/18236448
- http://www.ncbi.nlm.nih.gov/pubmed/14669250
- http://www.ncbi.nlm.nih.gov/pubmed/14646256
- http://www.ncbi.nlm.nih.gov/pubmed/1409765
- http://www.ncbi.nlm.nih.gov/pubmed/16203115
