Back Pain Relief Without Drugs
Back Pain Relief Without DrugsMay 9th, 2019 by Cindy Perlin, LCSW
There has been a recent surge in interest in how to achieve back pain relief without drugs. This is the result of growing awareness that pharmaceutical treatments have caused significant harm.
The shift in opinion is also a response to the growing body of evidence demonstrating the effectiveness and safety of many nonpharmacologic treatments for back pain. What follows is a brief review of selected alternative treatments.
Acupuncture for Back Pain Relief Without Drugs
Acupuncture is a treatment system that involves inserting thin needles into specific points on the body in order to positively affect a patient’s health. The needles affect the flow of energy, known as qi. Acupuncture is a therapy that has been developed and refined over thousands of years and is part of traditional Chinese medicine (TCM).[xv]
Acupuncture has been the subject of significant research. This research has included studying its underlying mechanisms and its effect on clinical conditions, including pain. Studies have shown that acupuncture affects the supply of neurochemicals, including levels of endorphins, cortisol, serotonin, and dopamine.[xvi] Furthermore, other studies have shown changes in levels of brain activity with needling of acupuncture points.[xvii]
A 2007 study of 1,162 patients compared acupuncture, sham acupuncture (superficial needling at nonacupuncture points), and conventional therapy (a combination of drugs, physical therapy, and exercise) for effectiveness against low-back pain. The study concluded that both acupuncture and sham acupuncture were almost twice as effective as conventional treatment for chronic back pain. The improvements lasted at least six months.[xviii]
In a 2012 study that included individual patient data from 29 controlled studies with a total of 17,922 patients, researchers concluded that acupuncture is an effective treatment for chronic back and neck pain, osteoarthritis, and chronic headaches.[xix]
The World Health Organization states that acupuncture is safe if it is properly performed by a well-trained practitioner. WHO reported that acupuncture is nontoxic and that adverse reactions are minimal. Effects on pain were found to be comparable to morphine without the side effects and risks.[xx]
In summary, acupuncture has been found to be an excellent way to get back pain relief without drugs.
Biofeedback as an Alternative Treatment for Back Pain
Biofeedback is a treatment system that uses sensitive electronic instruments to measure a person’s bodily processes and then feeds back that information to the person so that control of the physiology can be learned. Several types of biofeedback have been shown to be helpful for reducing chronic pain. Biofeedback is often paired with coaching in relaxation techniques. These include muscle tension (EMG), temperature (blood flow), heart rate variability (HRV), and brain wave (neurofeedback)—
Biofeedback can enhance the effectiveness of relaxation training by giving the patient information on the effectiveness of his efforts. Biofeedback takes measurements on the surface of the body, and this information is used as part of an educational process. It is completely safe and without negative side effects.
In a study comparing EMG biofeedback, cognitive behavioral therapy, and conservative medical management for back pain and temporomandibular joint (jaw) pain, the biofeedback group had the most positive changes posttreatment. At 6- and 24-month follow-ups, only the biofeedback group had maintained significant improvements in pain severity, interference with daily activities, emotional distress, and reductions in use of the health care system for pain treatment.[xxi] In another study, 50 chronic pain patients were randomly assigned to a biofeedback-plus-relaxation training group or a pain education group. The biofeedback/relaxation group reported significantly less pain and anxiety compared to the pain education group.[xxii]
The power of biofeedback as an alternative treatment for back pain relief is in the power it gives patients to control their own bodies.
Chiropractic for Nonpharmacologic Treatment of Back Pain
Chiropractors diagnose, treat, and prevent disorders of the musculoskeletal system. More than 90% of patients who seek care from chiropractors are seeking relief from pain, including back and neck pain and headaches.[xxiii]
Many patients who are seeking back pain relief without drugs are afraid to try chiropractic treatment. In fact, chiropractic treatment has been found to be much safer than any conventional pain treatments.
According to a study sponsored by nonpartisan nonprofit research institute the RAND Corporation, the estimated risk for serious complications for cervical (neck) manipulation is 6.39 per 10 million manipulations. For low-back manipulation, the estimate is 1 serious complication for every 100 million manipulations. . Compare this to the 156,000 serious complications per 10 million cervical spine surgeries or the 32,000 serious complications per 10 million patients using nonsteroidal anti-inflammatory drugs (NSAIDs). The same literature review found that spinal manipulation was more effective for both acute and subacute low-back pain without sciatica than comparison treatments. In addition, the study found that cervical manipulation was effective for neck pain and muscle tension-type headaches.[xxiv]
In 1997, the U.S. Agency for Health Care Policy and Research reported that chiropractic spinal manipulation was one of the few evidence-based treatments recommended for the treatment of low-back pain.[xxv]
A systematic review published in 2017 in the Journal of the American Medical Association (JAMA) of 26 randomized clinical trials of spinal manipulation for acute low back pain found significant improvements in both pain and function.[xxvi]
Cognitive Behavioral Therapy for Back Pain Relief Without Drugs
Cognitive behavioral therapy (CBT) is based on the idea that thoughts affect behavior and emotions and that changing maladaptive thoughts can improve mood and functioning. Many chronic pain patients fear the consequences of their pain and worry about their ability to cope with it. They may have unrealistic fears that their resumption of normal activities at home and at work will result in further injury. These thoughts and fears may prolong or prevent recovery. CBT includes replacing unhelpful beliefs with more positive ones. It aso includes behavioral experiments, such as gradual exposure to feared situations and activities to reduce reactivity. These mental changes have been shown to be an effective way to achieve better emotional and physical well-being, including back pain relief without drugs.
A 2012 review of 46 randomized controlled studies of CBT for chronic low-back pain was effective in reducing pain. When compared with wait-list controls, CBT reduced pain, anxiety, avoidance, back-related worry, catastrophizing, depression, disability and stress. Furthermore, it increased coping, health-related quality of life (females only), pain control, pain self-efficacy, perceived ability to function, general quality of life and social support. CBT also offers economic benefits in terms of reduced health care visits, reduction in work days lost, and higher likelihood of return of work.[xxvii]
Many studies have shown that CBT and exercise in combination were as effective as back surgery over both the short and long term, with lower costs and fewer risks.[xxviii],[xxix],[xxx],[xxxi],[xxxii],[xxxiii]
A 2016 study published in JAMA found that both cognitive behavioral therapy and mindfulness-based stress reduction treatment of adults with chronic low back pain resulted in significantly greater improvement in back pain and functional limitations than with usual care.[xxxiv]
Relaxation as an Alternative Back Pain Treatment
It makes intuitive sense, based on what is now known about the connection between chronic pain and stress, that learning to become more relaxed would result in reduced pain. There are two types of relaxation techniques: active and passive. Active, or progressive, relaxation, produces lower arousal as specific muscles are voluntarily tensed and relaxed, and as the individual learns to differentiate between relaxation and tension. Passive relaxation includes deep breathing or using words or imagery to induce lower arousal. Meditation, for instance, involves focusing on a calming or neutral word or phrase to the exclusion of everything else, including habitual worries or fears. When negative stimuli are removed, the body moves toward relaxation. Effective relaxation strategies involve practicing the techniques frequently until a relaxed state can be achieved quickly in any time of need. This level of training in relaxation is called training to mastery.
Results of studies on relaxation as a treatment for chronic pain have found that different behavioral interventions that have a relaxing effect tend to significantly reduce pain, though there is not enough evidence to determine which relaxation techniques are most effective for which disorders. No studies have reported any negative side effects of relaxation training.[xxxv]
A multidisciplinary technology assessment panel convened by the National Institutes of Health in 1996 to evaluate the evidence base for behavioral and relaxation approaches in the treatment of chronic pain found that the evidence was strong for the use of relaxation techniques in alleviating chronic pain in many medical conditions.[xxxvi]
Low Level Laser Therapy for Chronic Back Pain Treatment
Low level laser therapy (LLLT) has been in use in Europe as a medical treatment for more than 40 years. It has only recently begun attracting significant interest in the United States as a way to achieve back pain relief without drugs. Two types of lasers are used for medical purposes. High power lasers are used to cut through tissue; low level lasers have the opposite effect—they stimulate tissue repair. In LLLT, a light is applied to an area of the body to relieve pain, reduce inflammation, and promote tissue regeneration. The light is usually a laser or LED between 1 mW and 550 mW in the red or near infrared spectrum. It’s typically applied to the injured area for a very short time a few times a week for a few weeks. The effect has been compared to photosynthesis, in which the absorbed light causes a chemical change in the tissue.[xxxvii]
Low level lasers promote healing through a process called photobiomodulation. LLLT increases the production of adenosine triphosphate (ATP), the fuel our cells use for energy. The more ATP available to our cells, the faster we heal. LLLT also increases the permeability of cell membranes, which allows waste products to be removed and nutrition to be absorbed into the cells more efficiently. LLLT secondary effects include anti-inflammatory effects, decreases in nerve irritability, and an increase in circulation in the area of injury or chronic pain. Whole-body effects from the treatment include increased immune cell production, increased production of endorphins (the body’s own painkillers), and improved nerve function.
Over 400 LLLT randomized clinical trials and more than 4,000 laboratory studies have been published.[xxxviii] A 2010 meta-analyses of 22 studies published in the Clinical Journal of Pain investigated the magnitude of relief experienced by patients receiving LLLT for a variety of chronic pain conditions. A statistically significant and large effect was found.[xxxix]
A 2015 study reported on a five-year follow-up of 50 back pain patients who had discography (a procedure to confirm that an abnormal disc was generating the pain) and who then were treated with LLLT. The patients received three LLLT sessions per week for 12 weeks. Forty-nine patients had significant improvement on a scale that measures disability at the end of the course of treatment. The improvements were found to be maintained at one-year and five-year follow-ups.[xl]
Massage and Bodywork for Drug-Free Pain Relief
Therapeutic massage and bodywork include a wide variety of techniques that involve manipulation of soft tissue or subtle energy to alleviate pain or resolve structural imbalances so that health and well-being are improved.[xli] There are many different types of massage and bodywork. These can be classified into three types of approaches:
- Gentle bodywork includes light application of touch, as in Swedish massage, craniosacral therapy, and lomi lomi massage. These techniques help the body relax and return to its natural state of balance. For treatment of pain, gentle bodywork techniques are best suited to patients in significant pain, at least initially, as they are less likely to aggravate the condition than forms of massage that use more pressure.
- Structural bodywork includes Rolfing, Hellerwork, and other schools of structural integration. The goal of this bodywork is to change structure by creating a direct change in muscles, tendons, ligaments, and other soft tissues to restore structural balance and reduce strain. The pressure applied with these techniques can create short-term pain.
- Deep tissue bodywork, which focuses on the alleviation of pain and discomfort, includes, in addition to deep tissue massage, neuromuscular therapy, Trager psychophysical integration, and myofascial release.[xlii]
A 2001 study of patients with chronic low-back pain found that 10 massage sessions significantly reduced pain and disability, with benefits still evident 9 to 10 months after completions of treatment.[xliii]
A 2008 Cochrane Collaboration review of 13 randomized trials of massage for low-back pain, which included a total of 1,596 participants, concluded that massage was more likely to work when combined with exercises (usually stretching) and education, and that the benefits outweighed those achieved by relaxation, physical therapy, education in self-care, or acupuncture. Acupressure, or pressure point massage techniques, seemed to provide greater relief than Swedish massage did.[xliv]
A large 2011 randomized controlled study compared two types of massage—structural and relaxation—to usual care for people 20 to 65 years old with nonspecific chronic low-back pain. The treatment groups received 10 massages over a 10-week period by experienced massage therapists. Both massage groups had similar functional outcomes and symptom bothersomeness scores that were significantly superior to usual care. Benefits persisted for at least six months.[xlv]
A 2014 study comparing the effects of deep tissue massage on low-back pain to deep tissue massage plus NSAIDs found that 10 deep tissue massages of 30 minutes each effectively reduced low-back pain and associated disability. No additional benefit was seen from adding NSAIDs to the treatment.[xlvi]
Medical Marijuana for Back Pain Relief
Marijuana grows wild in all but the coldest climates all around the world. It has been used medicinally for thousands of years. Marijuana was part of the US Pharmacopeia until 1941, when anti-drug zealots had it banned. The marijuana plant contains more than 100 substances known as cannabinoids, which are unique to the plant.
The most well-known cannabinoids are THC and CBD.[xlvii] The brains of mammals also produce substances known as endocannabinoids, which have been referred to as “the brain’s own marijuana.”[xlviii] Whether they are produced by the body (endogenous) or derived from plants or synthetic formulations (exogenous), cannabinoids bind with receptors on cells throughout the body to create their effects.[xlix] These cannabinoid receptors are involved in metabolic regulation, craving, pain, anxiety, bone growth, and immune function.[l]
A survey of 100 consecutive medical marijuana patients who were returning for their annual recertification in Hawaii found that 97% used marijuana primarily for relief of chronic pain. They reported an average 64% decrease in pain—a decrease on a 10-point pain scale from 7.8 to 2.8. Half also reported relief from stress and anxiety; 45% reported insomnia relief; and 71% reported no negative side effects. No serious adverse effects were reported. Some of the patients reported they were able to reduce or eliminate their use of opioids.[li]
A more recent survey of medical marijuana users found an average reduction in symptom severity of almost 75%. Most of those surveyed were using marijuana for treatment of chronic pain.
The Nutrition/Pain Connection
Some common nutritional deficiencies have been found to be associated with chronic pain. Supplementation with these nutrients has been found to provide relief. For instance, correcting the following nutritional deficiences has been associated with pain reduction: vitamin D[lii], magnesium[liii] and Omega-3 fatty acids[liv]
In addition, many foods promote inflammation while others reduce inflammation. Inflammatory foods include sugar, white flour and other processed carbohydrates and red meat. Anti-inflammatory foods include fruits and vegetables, olive oil and fish.
Changing your diet to address nutritional deficiences and reduce inflammation is another powerful way to achieve back pain relief without drugs.
Physical Therapy for Drugfree Back Pain Relief
Physical therapists develop an individualized treatment plan. The goal is to increase mobility, reduce pain, improve function, and prevent disability.[lv] Physical therapists use a variety of techniques, which include heat, cold, water, ultrasound, electrical stimulation, manual therapy, and exercise.[lvi]
Manual therapy is treatment performed mostlyly with the hands. Manual therapy can include massage; mobilization (movement to loosen tight tissue around a joint to improve flexibility and alignment); and manipulation (pressure applied to a joint with hands or a special device).[lvii] Exercise can include stretching, core-strengthening exercises, lifting weights, and walking. It may also include instruction in a home-exercise program.[lviii]
A review of randomized controlled trials from 1961 to 2009 found strong evidence for the use of manual therapies in the treatment of chronic low-back pain and knee pain.[lix]
Many alternative therapies exist that can provide back pain relief without drugs. Unfortunately, there are many stumbling blocks to utilization of these therapies. These include lack of patient and provider awareness, lack of insurance coverage and limited availability in many communities.
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