Low Back Pain
Low back pain has many causes. The most common is an acute strain of the muscles and ligaments of the spine. Acute low back pain often starts quickly and is the result of an injury. Most people improve within 2 or 3 weeks. Chronic back pain may happen slowly. Its cause is more complex and harder to find. The recovery also takes longer. Both types of pain are common and may impact daily tasks.
Standard treatments include over-the-counter and prescription medications, physical therapy, and waiting for the pain to go away. Some patients seek alternative medicine treatments to help manage pain when standard treatments aren’t working. Alternative treatment may help manage symptoms or prevent future episodes of pain.
Since most cases of acute low back pain resolve on their own, the following therapies focus primarily on natural therapies for chronic low back pain.
- Acupuncture is an ancient technique of traditional Chinese Medicine that involves inserting fine needles at specific points to improve the flow of Qi (a form of “vital energy”). It may be more effective than standard treatment alone for low back pain and function.A1, A3, 79, A2, A4, C3, B7
- Chiropractic involves a variety of techniques aimed at realigning the joints of the spine and increasing their pain-free range of motion. The most common technique, controlled pressure, is applied to individual spinal joints. Spinal manipulation may reduce back pain and improve function, but its effectiveness may be similar to that of other standard and non-standard therapies .B1, B2, B3, B4, B5, B6, B7
- Osteopathic Manipulation involves soft tissue stretching, spinal mobilization, and other techniques aimed at relaxing muscles and improving range of motion. It may be more effective than some standard treatments for low back pain.E1, E2. E4, E3
The following herbs and supplements may be effective in reducing back pain:
- White willow bark (Note: White willow bark contains salicin, which is chemically related to aspirin. It may cause problems when used with common over-the-counter pain relievers, such as ibuprofen.)I3, I5
- Topical capsaicin I2, I5
- Comfrey J1, I5
- Devil's Claw I1, I5
The following alternative therapies may be effective in reducing back pain:
Possibly Not Effective
- Magnet therapy K4
Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.
Herbs and Supplements to Be Use With Caution
Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions. One supplement discussed here has certain concerns such as:
A1. Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Int Med . 2003;138:898-906.
A2. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892-1898.
A3. Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.
A4. Cherkin DC, Sherman KJ, AVins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858-866.
B1. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Med. 1974;31:59-64.
B2. Aure OF, Hoel Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525-531.
B3. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131-137
B4. Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008112.
B5. Rothberg S, Friedman BW. Complementary therapies in addition to medication for patients with nonchronic, nonradicular low back pain: a systematic review. Am J Emerg Med. 2017 Jan;35(1):55-61.
B6. Stochkendahl MJ, Kjaer P, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2017 Apr 20. doi: 10.1007/s00586-017-5099-2.
B7. Yeganeh M, Baradaran HR, et al. The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis. Complement Ther Clin Pract. 2017 May;27:11-18.
C1. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.
C2. Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011;155(1):1-9.
C3. Kumar S, Rampp T, et al. Effectiveness of Ayurvedic massage (Sahacharadi Taila) in patients with chronic low back pain: a randomized controlled trial. J Altern Complement Med. 2017 Feb;23(2):109-115.
C4. Elder WG, Munk N, et al. Real-world massage therapy produces meaningful effectiveness signal for primary care patients with chronic low back pain: results of a repeated measures cohort study. Pain med. 2017 Mar 14.
D1. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain. 2007 May 31. [Epub ahead of print]
D2. Esmer G, Blum J, Rulf J, Pier J. Mindfulness-based stress reduction for failed back surgery syndrome: a randomized controlled trial. J Am Osteopath Assoc. 2010;110(11):646-652.
D3. Counseling and education for chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T910282/Counseling-and-education-for-chronic-low-back-pain. Updated January 2, 2017. Accessed July 12, 2017.
E1. Andersson GB, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426-1431.
E2. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-1362.
E3. Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013 Mar-Apr;11(2):122-9.
E4. Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014 Aug 30;15:286. doi: 10.1186/1471-2474-15-286.
F1. Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-146.
F2. Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.
F3. Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-1259.
F4. Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004;29:9-16.
G1. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken) . 2011;63(11):1576-1583.
G2. Stochkendahl MJ, Kjaer P, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2017 Apr 20. doi: 10.1007/s00586-017-5099-2.
H1. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. A randomized, controlled trial. Ann Intern Med. 2005;143:849-856.
H2. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107-117.
H3. Tekur P, Singphow C, Nagendra HR, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14:637-644.
I1. Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor and vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10-18.
I2. Frerick H, Keitel W, Kuhn U. Topical treatment of chronic low back pain with a capsicum plaster. Pain. 2003;106:59-64.
I3. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9-14.
I4. Kucera M, Barna M, Horacek O, et al. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study. Adv Ther. 2005;22:681-692.
I5. Oltean H, Robbins C, et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014 Dec 23;(12):CD004504.
J1. Kucera M, Barna M, Horacek O, et al. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study. Adv Ther. 2005;22:681-692.
K1. Thermal and electromagnetic therapies for chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T906118/Thermal-and-electromagnetic-therapies-for-chronic-low-back-pain. Updated March 23, 2015. Accessed July 12, 2017.
K2. Nielson WR, Weir R. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain. 2001;17:S114-127.
K3. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ. 2008;337:a884.
K4. Pittler et al. Static magnets for reducing pain: systematic review and meta-analysis of randomized trials. CMAJ. 2007 Sep 25;177(7):736-42.
Last reviewed February 2019 by EBSCO NAT Review Board Richard Glickman-Simon, MD Last Updated: 2/22/2019