Integrative & Natural Approaches to Back Pain
Back pain is one of the most common health concerns, with more than 80 percent of Americans experiencing low back pain at some point in our lives. It is one of the most common reasons people miss work or visit the doctor.
Here are some natural remedies for back pain which may offer relief for mild to moderate back pain, particularly when part of a comprehensive treatment plan.
What is conventional treatment?
Most acute back pain will resolve on its own within two weeks without medical intervention. Whether lower back pain is acute or chronic, most cases can be initially treated with over-the-counter pain relievers to reduce discomfort and with anti-inflammatory drugs to reduce inflammation. Sometimes, prescription drugs may be recommended for pain relief and to allow quality sleep. Cold and hot compresses may help reduce pain and inflammation and allow greater mobility, although they have not been scientifically proven to quickly resolve low back injury. Bed rest is recommended for only 1-2 days at most, and patients are advised to resume their normal activities as soon as possible. Massage therapy can be very useful in cases of acute muscle spasm causing back pain and problems with flexibility. Exercise may be the best way to speed recovery and strengthen back and abdominal muscles. Physical therapy may be recommended for more severe strains. In the most serious cases that do not respond to other forms of treatment, and that involve compromised structures in the spine, surgery may be recommended to relieve pain caused by back problems or serious musculoskeletal injuries.
alternative Approaches to Back Pain
Anti-Inflammatory Herbs
Since inflammation is thought to play a role in the development of back pain, certain herbs that have anti-inflammatory effects may be useful for back pain relief.
Willow bark
White willow bark may have pain-relieving properties similar to aspirin. Salicin, a compound found in white willow bark, is converted in the body to salicylic acid, similar to aspirin. The mechanism of action is thought to be through the combined anti-inflammatory effects of salicin and flavonoids, without affecting the gastrointestinal (GI) mucosa or blood clotting as seen with aspirin.
Capsaicin Cream
Although you may not have heard of capsaicin before, if you've ever eaten a chili pepper and felt your mouth burn, you've experienced its effects. Capsaicin is the active ingredient in chili peppers. When it is applied to the skin, capsaicin has been found to deplete a neurochemical that transmits pain, causing an analgesic effect.
In a 2011 research review published in the British Journal of Anaesthesia, investigators looked at the available research on the use of topically applied capsaicin in the treatment of several types of chronic pain. This included two clinical trials examining back pain, both of which found that capsaicin helped reduce low back pain without causing notable side effects.
Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area. If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin.
Ginger
Ginger extract may help with joint and muscle pain because it contains phytochemicals, which help stop inflammation. Ginger has active constituents known as gingerol, shogoal, and paradol. These constituents are the key players responsible for the anti-inflammatory effects ginger provides which have been shown to inhibit the production of pro-inflammatory cytokines (small proteins released by cells to communicate with other cells in the body). Ginger is safe with few side effects.
Feverfew
Feverfew has been used for centuries to treat headaches, stomachaches, and toothaches. Nowadays it's also used for migraines and rheumatoid arthritis. The herb may be worth trying since it has not been associated with serious side effects. Mild side effects include canker sores and irritation of the tongue and lips. Pregnant women however should avoid this remedy.
Turmeric
This spice has been used to relieve arthritis pain and heartburn, and to reduce inflammation. The active component of turmeric is curcumin which reduces inflammation through several biological mechanisms, including nuclear factor-kappa B (NF-kB), C-reactive protein, cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), interleukin (IL)-1beta, IL-6, IL-10, IL-12, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma, activator protein-1, macrophage inflammatory protein (MIP), matrix metalloproteinase (MMPs), human leukocyte elastase (HLE), several types of protein kinases, adhesion molecules, and genes involved in inflammation. Turmeric is safe to use, but very high doses or long-term use may cause indigestion.
Devil's Claw
Devil’s claw comes from the roots of the Harpagophytum species, a perennial plant native to southern Africa. Its healing properties have been known for centuries and have been traditionally used for a variety of symptoms. It’s most common use is in the treatment of pain. A 2007 review of the evidence found five systematic reviews on devil’s claw, with strong evidence of effectiveness in low back pain and osteoarthritis pain of the knee and hip. Its effect was found to be similar to NSAIDs (aspirin, mortin etc). The review concluded by stating “since there is strong evidence for devil’s claw… the possible place in the treatment schedule before NSAIDs in the treatment of back pain should be considered.”
Vitamin D
A growing body of research suggests a link between chronic pain that does not respond to treatment and vitamin D deficiency. Vitamin D supplements may lead to clinical improvement in pain symptoms among people with low initial concentrations of vitamin D. An essential nutrient available in certain foods (such as fortified milk and fish with small bones), vitamin D is produced naturally by the body during exposure to the sun's ultraviolet rays. But it is difficult to obtain the recommended daily intake of D solely through dietary sources and sun exposure, many medical experts recommend increasing your vitamin D levels by taking a dietary supplement. The dose to take however is important and checking your vitamin D levels should be done first by a qualified medical professional.
Magnesium
Magnesium is the fourth most abundant mineral in the body. Involved in over 300 biochemical reactions, it helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and preserves bones strength. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis.
Research shows that certain forms of magnesium can be effective for pain relief and muscle relaxation, as well as nerve pain. Many people in our society are magnesium deficient, so it may be a good idea to supplement. Magnesium glycinate is known to be a highly bioavailable form. Magnesium citrate can be used by those who tend toward constipation, as it has an additional effect of loosening the bowels.
Vitamin B12
Pain, as well as numbness and tingling, irritability, mild memory impairment, and depression, can be symptoms of B12 deficiency. Risk factors for vitamin B12 deficiency include:
- Pernicious anemia
- Use of certain medications (including stomach acid-blocking medications)
- Inadequate intake of meat or dairy products
- Infection (such as small intestine bacterial overgrowth, parasites)
- Digestive diseases (including celiac disease and Crohn's disease)
Vitamin B12 muscle injections are the standard treatment for vitamin B12 deficiency. Studies have found that vitamin B12 sublingual tablets (placed under the tongue for absorption) and nasal gel are also effective.
Massage Therapy
Whether or not research can prove that massage therapy helps, many people report that it relaxes them and eases chronic pain. In a 2009 research review published in Spine, researchers reviewed 13 clinical trials on the use of massage in the treatment of back pain. The study authors concluded that massage "may be beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education." The authors called for further studies that might help determine whether massage is a cost-effective treatment for low back pain. Massage therapy may also alleviate anxiety and depression associated with chronic pain. It is the most popular natural therapy for low back pain during pregnancy.
spinal manipulation
Chiropractors use spinal manipulation to restore joint mobility. They manually apply a controlled force to joints that have become restricted by muscle injury, strain, inflammation, and pain. Manipulation is believed to relieve pain and muscle tightness and encourage healing.
Chiropractic care involving spinal manipulation appears to reduce symptoms and improve function in patients with chronic low back pain, acute low back pain, and sub-acute low back pain, according to a research review published in the Journal of Manipulative Physiological Therapeutics. In their analysis of 887 documents (including 64 clinical trials), the review's authors concluded that combining chiropractic care with exercise is "likely to speed and improve outcomes" and protect against future episodes of back pain.
Acupuncture
A 2008 study published in the journal Spine found "strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy" for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found "moderate evidence that acupuncture is more effective than no treatment" in relief of back pain.
How does acupuncture work? According to traditional Chinese medicine, pain results from blocked energy along the meridians of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways. Acupuncture may also release natural pain-relieving opioids, send signals to the sympathetic nervous system, and release neurochemicals and hormones.
If you are interested in trying acupuncture for your chronic pain, plan on going one to three times a week for several weeks initially.
Tai Chi
Tai chi is an ancient form of martial arts that involves slow, graceful movements and incorporates meditation and deep breathing. Although research on the use of tai chi in the treatment of back pain is somewhat limited, there is some evidence that practicing tai chi may help alleviate back pain to some degree. The available science includes a 2011 study published in Arthritis Care & Research, which found that a 10-week tai chi program reduced pain and improved functioning in people with long-term low back pain symptoms. The study involved 160 adults with chronic low back pain, half of whom participated in 40-minute-long tai chi sessions 18 times over the 10-week period.
Yoga
Yoga creates balance in the body through various poses that develop flexibility and strength. There's some evidence that taking up a yoga practice may help relieve back pain. A 2011 research review published in Clinical Rheumatology, investigators looked at seven clinical trials that tested the effects of yoga in patients in with low back pain. Of those studies, five suggested that yoga leads to a significantly greater reduction in low back pain than usual care, education, or conventional therapeutic exercises.
Alexander Technique
Alexander Technique is a type of therapy that teaches people to improve their posture and eliminate bad habits such as slouching, which can lead to pain, muscle tension, and decreased mobility. There is strong scientific support for the effectiveness of Alexander Technique lessons in the treatment of chronic back pain, according to a research review published in the International Journal of Clinical Practice in 2012. The review included a well-designed, well-conducted clinical trial demonstrating that Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. These results were broadly supported by a smaller, earlier clinical trial testing the use of Alexander Technique lessons in the treatment of chronic back pain.
A typical session lasts about 45 minutes. During that time, the instructor notes the way you carry yourself and coaches you with verbal instruction and gentle touch.
Balneotherapy
One of the oldest therapies for pain relief, balneotherapy is a form of hydrotherapy that involves bathing in mineral water or warm water.
In a 2006 report published in Rheumatology, investigators analyzed the available research on the use of balneotherapy in treatment of low back pain. Looking at five clinical trials, the report's authors findings suggest that balneotherapy may be effective for treating patients with low back pain. Noting that supporting data are scarce, the authors call for larger-scale trials on balneotherapy and low back pain.
Dead Sea salts and other sulfur-containing bath salts can be found in spas, health food stores, and online. However, people with heart conditions should not use balneotherapy unless under the supervision of their primary care provider.
Meditation
An ancient mind-body practice, meditation has been found to increase pain tolerance and promote management of chronic pain in a number of small studies. In addition, a number of preliminary studies have focused specifically on the use of meditation in the management of low back pain. A 2008 study published in Pain, for example, found that an eight-week meditation program led to an improvement of pain acceptance and physical function in patients with chronic low back pain. The study included 37 older adults, with members meditating an average of 4.3 days a week for an average of 31.6 minutes a day.
Although it's not known how meditation might help relieve pain, it's thought that the practice's ability to induce physical and mental relaxation may help keep chronic stress from aggravating chronic pain conditions. One of the most commonly practiced and well-studied forms of meditation is mindfulness meditation.
Music Therapy
Music therapy is a low-cost natural therapy that may reduce some of the stress of chronic pain in conjunction with other treatments. Studies find that it may reduce the disability, anxiety, and depression associated with chronic pain. It is thought to help because it can shift attention away from the unpleasant sensations of pain, and it may cause the release of endorphins or changes in catecholamine levels.
Using Natural Remedies
If you're considering using alternative medicine for back pain, talk with an integrative medicine doctor first. It's important to note that self-treating with alternative medicine and avoiding or delaying conventional treatment may be harmful to your health.