The new guidelines of the America College of Physicians (ACP) for the management of low back pain for physicians, offers a multitude of suggested interventions related to chronic low back pain. https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain/. They group back pain as acute/subacute (less that 3 months) or chronic (over three months). That said the list provided for interventions related to chronic back pain is rather extensive.
How is a person to choose? Here is a brief run-down of the options that you have in addition to NSAIDs and muscle relaxers if your back pain is not just the “simple” kind:
- Heat: It’s main function is to cause vasodilation, or increase the size of the small vessels of the area to increase blood flow and pain relief. On the opposite side of the coin is ice which has just the opposite effect but also provides pain relief.
- Massage: Hands-on tissue massage by a massage therapist can help to relieve tightness, stress and in some cases, scar tissue. These can help with pain relief.
- Acupuncture: This intervention utilizes points of the body, often with use of a needle, to relieve stress and assist with medical conditions.
- Spinal Manipulation/Mobilization: This is a high-amplitude movement, provided to a joint that causes the release of air and the “crack” noise associated with it. It relieves pressure, provides a stretch and can also relieve pain. Physical Therapists, Chiropractors and Doctors of Osteopathy (D.O.) can provide this intervention.
- Tai Chi: Low impact, mindful, balance and exercise, said to have the ability to relieve stress and anxiety.
- Yoga: Mind body emphasis, low impact, utilizing stretching and strengthening.
- Cognitive behavior/Operant therapy: These are methods to assist overcome some of the limitations associated with having pain for a longer time. These can be helpful changing pain mindset.
- Rehabilitation Mindfulness: The use of mindfulness with rehabilitation is a newer approach used with pain management. It has many definitions and can include meditation, cognitive approaches and other techniques.
- Specific Exercise/Motor control exercise (MCE): There is little evidence to say which exercises are the best to use for the low back but what they do say is good core muscle activation is a necessity. These techniques focus on strengthening both postural muscles and the abdominal wall.
- Progressive relaxation: As the name suggests, practicing a progressive relaxation series can decrease stress which can also decrease pain.
- Electromyography biofeedback: This includes the use of biofeedback and sometimes more invasive methods using muscle stimulation with electrodes, allows close monitoring of muscle contraction.
- Low level laser therapy: This modality has been suggested as assisting pain reduction. It is not available widely and its use is newer in the United States.
The bottom line is this: Find an educated provider who is well aware of the intervention that you seek. Also realize that different professions, other than medicine, do treat this condition differently. There are many good interventions noted here, not all of which may be the one that makes you feel better. The key is finding that provider who knows the current evidence and is willing to work with you as an individual to manage your specific symptoms.