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Which complementary therapies work for back pain?

Professor of complementary medicine Edzard Ernst and colleagues look at which therapies work, which don’t and which might cause harm in treating back pain

Professor of complementary medicine Edzard Ernst and colleagues look at which therapies work, which don't and which might cause harm in treating back pain

Back pain is the most frequent reason for people to try complementary and alternative medicines, particularly acupuncture, herbal medicines, massage, chiropractic and osteopathy.

Clinical bottom line

Likely to be beneficial

Acupuncture: Even though data are somewhat contradictory, the totality of the evidence suggests acupuncture reduces chronic back pain.

Capsaicin (topical): Seems to reduce pain more than placebo.

Devil's claw (Harpagophytum procumbens): Seems an effective symptomatic treatment.

Massage: Most trials suggest pain relief.

Osteopathic treatment: Seems to reduce pain.

Relaxation: Short-term pain relief and functional improvement.

Willow (Salix alba): Seems to reduce pain.

Trade-off between benefits and harms

Spinal manipulation: Superior to demonstrably harmful treatments in this condition (such as bed rest) and superior to sham manipulation, but not more effective than conventional options, such as exercise. Upper spinal manipulation has been associated with stroke and death.

Unknown effectiveness

Alexander technique: Not enough data.

Auricolotherapy: Not enough data available.

Biofeedback: Not enough data available.

Topical comfrey (Symphytum officinale) Not enough data available.

Music therapy: Not enough data available.

Water injections: Not enough data available.

Yoga: Not enough data available.

Conclusions

Acupuncture, capsaicin, devil's claw, massage, osteopathy, relaxation, spinal manipulation and willow extracts might all be promising treatments for back pain.

Spinal manipulation can be associated with considerable risks. None of the other treatments above are associated with serious risks. For these interventions, the risk-benefit balance is therefore positive.
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Professor Edzard Ernst is professor of complementary medicine at Peninsula Medical School, Universities of Exeter and Plymouth.

Dr Max Pittler is senior research fellow in complementary medicine.

Barbara Wider is research fellow in complementary medicine.

Kate Boddy is information officer in complementary medicine.

This is an extract from the Oxford Handbook of Complementary Medicine, which offers evidence-based analysis of therapies

ISBN 978-0-19-920677-3

Although the evidence is contradictory, acupuncture is likely to be effective for chronic back pain evidence

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