Alternative Approaches to Low Back Pain

Alternative Approaches to Low Back Pain
Got back pain? Alternative therapies might help.
By Gina Shaw
WebMD FeatureReviewed by Laura J. Martin, MD, MDHave you ever had back pain? If so, you’re not alone. About 8 out of every 10 people have acute (sudden) or chronic (long-lasting) back pain at some point in their lives.

Most acute back pain goes away on its own, whether or not you treat it with medication or other therapies.

But sometimes it doesn’t.

You might think that if you have chronic low back pain — pain that lasts longer than about six to eight weeks — that you’ll need medication, surgery, or both to help get relief.

But there are dozens of alternative treatments for chronic back pain that don’t involve taking medication or having an operation. And many of them are much more popular.

“Americans spend much more out of pocket for alternative pain therapies than they will for traditional treatments,” says Barry Cole, MD, director of the American Society of Pain Educators. “People value these treatments enough to pay cash!”

Some alternative approaches to back pain are more established than others, and some have more scientific evidence supporting them. Here is an overview.

Physical Therapy for Back Pain
The right kind of physical therapy can often curb chronic back pain.

“When you visit a physical therapist, there are a number of things they might do,” says Sam Moon, MD, MPH, of Duke Integrative Medicine, part of Duke University Medical Center. “They might use machines or traction, they might put you through stretching exercise, or they might use hands-on techniques.”

Moon says the types of physical therapy shown to be most helpful for chronic back pain are hands-on soft tissue mobilization — in which the therapist moves the soft tissues of your back — and education about posture and home exercise.

Effective physical therapy should always include learning what to do at home — and then doing it.

Getting physical therapy twice a week and then sitting in your usual bad posture, or avoiding exercise, won’t help. Physical therapy should be goal-oriented and “shouldn’t go on forever,” Moon says.

Chiropractic/Spinal Manipulation
Doctors of chiropractic use their hands, and sometimes other tools, to manipulate the joints of the body — particularly the spine — to help relieve pain.

Studies have shown that chiropractics can be effective in relieving acute (sudden) and chronic back pain, although there’s more evidence to support its use in acute back pain.

“Chiropractic is generally considered to be as good as physical therapy, and as good as patient education, in relieving back pain,” Moon says. “And, like physical therapists, chiropractors can be very good educators about back health.”
Acupuncture for Back Pain
Acupuncture for back pain involves inserting very thin needles into specific points on your body. This traditional Chinese therapy is thought to balance the flow of energy in your body.

Acupuncture is generally considered to be very safe, and Moon commonly recommends acupuncture for back pain.

“There is definitely some evidence that it’s effective, although the evidence is even better for other pain conditions, like knee pain from arthritis and tennis elbow,” Moon says. “When I recommend acupuncture, I start the patient out with a series of four to five initial treatments, just to see if this person is an acupuncture responder.”

Therapeutic Massage for Back Pain
Certain types of massage can help relieve back pain.

“I think there’s enough [evidence] to advocate its use to help with low back pain,” Moon says. “I wouldn’t recommend it by itself, but combined with other approaches, I think it can be useful.”

Mind-Body Therapies for Back Pain
Techniques fit under the umbrella of mind-body therapies for back pain, including:

Guided imagery
Hypnosis
Biofeedback
Relaxation therapy
Talk therapy
Some are harder than others to test scientifically, and it’s hard to pinpoint if one type of mind-body therapy is more effective than another. But in general, research has shown that these kinds of therapies can be effective in treating back pain.

“For persistent back pain, I almost always recommend some type of mind-body therapy,” Moon says. Which kind? It depends on what kind of therapy appeals to you, as well as what’s most easily available in your area.

Mindful Movement
Another category of treatments for back pain is called mindful movement.

These therapies include common options found in many gyms, like yoga and t’ai chi, and other movement-based therapies like the Alexander technique and the Feldenkrais technique. All involve using different positions and types of movement to help relieve your back pain.

“The jury is still out on these techniques,” Moon says. “There are some studies that say that they do help with back pain, and some that say they don’t. But there is no strong evidence against them, and I have seen these techniques be effective, especially for people who have habits of moving their bodies in ways that can lead to pain.”

Finding Treatment
If you want to try chiropractic, biofeedback, massage, or yoga for your back pain, referrals are the best way to find help, Cole says.

“If you have a good relationship with your primary care doctor, they’ve seen thousands of patients a year and they learn about resources in your community,” he says. “Or ask your neighbor, or someone at your gym. Someone else who might not come to mind right away: a hospital social worker. They know a lot about resources in the community. And they can at least tell you who not to go to — bad news travels fast!”

Just as with physical therapy, chiropractic care for back pain should involve learning exercises to do at home to strengthen your back, and treatments shouldn’t go on forever.

“They should be teaching the patient how to take care of themselves,” Moon says. “I won’t write an open-ended prescription for chiropractic; generally, I think it should be done for a month or two before re-evaluating how the patient is doing.”

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Allergies

At least one out of every 5 Americans suffers from allergies. Common causes of allergy symptoms include food allergies such as peanut allergy or milk allergy, and seasonal allergies resulting from grass, weed, tree pollen, or various molds. Cat allergies and dog allergies can also cause miserable symptoms such as itchy eyes, sneezing, nasal congestion, and wheezing. Allergic skin conditions can cause a rash and itchy skin.

Symptoms & Types
Font SizeA A A Sneezing, difficulty breathing, cramps, and vomiting–all are allergy symptoms. Learn the types of allergies, specific allergy symptoms, and emergency warning signs.

Symptoms
What Are Typical Allergy Symptoms?
Learn the difference between mild and severe allergy symptoms.

Related Web Site: Severe Allergy Symptoms – Know What to Watch For
The reaction will depend on the body part involved and the severity of the reaction. Here’s what to look for.

Types
Hay Fever (Allergic Rhinitis)
Alllergic rhinitis, also known as hay fever, is an allergic response to pollen or other microscopic substances.

Hives (Urticaria)
Find out what causes hives and how to treat them.

Poison Ivy and Plant Allergies
Many people think poison ivy is contagious. Find out if that’s true and the best way to prevent poison ivy and other plant allergies.

Bee Sting Allergy
A normal reaction to a bee sting is different from a bee sting allergy. Do you know the difference?

Pet Allergies: What You Can Do
An allergy specialist shares her tips on dealing with pet allergies. And she should know. She has a cat, a dog, and many family members who have dog and cat allergies.

Latex Allergy
Learn about latex allergy symptoms and what to do in case of a severe reaction.

Mold Allergy
Mold is present in most indoor and outdoor spaces, and in many foods. Find out more about mold allergy symptoms and common food sources of mold.

Cosmetic Allergies
Are you allergic to certain cosmetics or makeup?

Drug Allergies
How do you tell the difference between a normal side effect a drug allergy? Find out here.

Eczema (Atopic Dermatitis)
This itchy skin rash, common in children and infants, affects some people all their lives.

Eye Allergies (Allergic Conjunctivitis)
How can you tell the difference between pink eye and eye allergies? Get started here.

Understanding Food Allergies
Do you get a reaction when you eat nuts, shellfish, or other foods? Learn what’s causing those food allergy symptoms.

Milk Allergy
Many unsuspecting products contain milk or milk products. Check our list.

Egg Allergy
If you have an egg allergy, check this food list for potential problems.

Nut Allergy
A nut allergy can become very serious, even fatal, rapidly. This food list will help you identify potential problems.

Fish Allergy
Some unexpected foods contain fish. If you’ve got a fish allergy, these tips will help keep you safe.

Shellfish Allergy
For most people with shellfish allergies, all shellfish must be avoided. Check out this list to learn which foods to avoid.

Soy Allergy
This allergy is most common among infants. By age two, the majority of children outgrow it. Find out more about the symptoms and how to avoid soy products.

Sun Allergy
Learn more about photosensitivity – an allergic response to sunlight.

Wheat Allergy
Knowing which ingredients to look for is key to avoiding a wheat allergy. Check this list for unsuspected products that contain wheat.

Aspirin Allergy (Salicylate Allergy)
How to recognize and treat salicylate allergy, or aspirin allergy.

Sulfite Allergy
About 1% of people have a sulfite allergy. This article has a list of foods that may contain sulfites.

Fall Allergies
Learn more about what triggers allergies in the fall season.

Warning Signs
Severe Allergies
A severe allergic reaction can be life-threatening. Learn more about the reaction called anaphylaxis so you can be prepared.

Complications
Allergies and Asthma
Allergies are a main trigger for asthma attacks. See what an asthma attack looks like in the lungs and learn the early warning signs.

Related Guide: Children, Allergies and Asthma
How can you tell if your child’s allergies are causing asthma? Find out how to spot the symptoms and learn how asthma is treated in children.

Sinus Infection (Sinusitis)
Hay fever allergies can cause sinus blockage and infection. Learn how to spot sinus infection symptoms and how to treat the problem.

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The Secrets of Managing GERD and Heartburn

By R. Morgan Griffin

Are you still trying to manage your heartburn and GERD by drinking milk by the gallon and popping antacids by the fistful? Chances are you’re not getting the relief you want. But the good news is with the right GERD treatment you can find relief.

“We’re more aggressive about treating GERD today,” says Lawrence Cheskin, MD. Cheskin is a gastroenterologist and an associate professor at the Johns Hopkins Bloomberg School of Public Health. He tells WebMD there are two reasons for the change. One is that GERD treatments are better. And the other is that the long-term risks of untreated gastroesophageal reflux disease are better understood.

Who Needs GERD Treatment?
There are many good reasons to treat GERD. First, GERD treatment makes you feel better. Living with uncontrolled GERD — the pain, the cough, the sleepless nights — can be tough.

“GERD puts quite a burden on a person’s quality of life,” says Goutham Rao, MD. Rao is a board member of the National Heartburn Alliance and an associate professor at the University of Pittsburgh School of Medicine. “GERD,” he says, “can be truly debilitating.”

Second, GERD poses some serious long-term health risks. Over time, the damage to the esophagus can cause complications. One of those is a condition called Barrett’s esophagus, which is associated with a small but significant risk of esophageal cancer. Fortunately, GERD treatment can prevent Barrett’s esophagus from developing.

How do you know if you need treatment for GERD? What’s the difference between harmless heartburn and more serious GERD? It’s not so much the severity, experts say, but the frequency.

The usual recommendation is that anyone with symptoms two or more times a week should see a doctor. Cheskin is more cautious. He says that even symptoms that occur just once a week should be checked out. “Over the years,” he says, “even that level of heartburn can cause damage.”

Sometimes the most obvious sign of trouble is how often you use over-the-counter (OTC) treatments for heartburn relief.

“For me, it got to a point where I was using Tums like they were going out of style,” says Carmen Butschlick of Milwaukee, who was diagnosed with GERD in 2006. “And I was still having symptoms. That’s when I knew I had to go see a doctor.”

GERD Treatments: Medications
Medications — both prescription and over-the-counter — are the most common treatment for GERD and heartburn relief. Here’s a rundown of your options.

Proton pump inhibitors (PPIs). If you have GERD, the odds are you’ll be prescribed one of these. This class of drugs — which includes Aciphex, Nexium, Prevacid, Prilosec, and Protonix — is now the standard GERD treatment. Not only do they help block the production of acid in the stomach, they also protect the esophagus from damage and allow it to heal.
GERD Treatments: Medications continued…
“The proton pump inhibitors are a terrific class of medications,” says Rao. “They’re very effective, and they appear to be quite safe.” They’re even helpful in diagnosing GERD, Rao says. If they work, you probably have GERD. If they don’t, you probably have something else.

Like any medication, they can have side effects. There’s some concern that they may cause a small increase in the occurrence of weakened bones in older people. While the benefits of well-controlled GERD generally outweigh this risk, you should discuss it with your doctor.

H2 blockers. These come as prescription and OTC medicines. They include drugs like Axid, Pepcid, Tagamet, and Zantac and were once the standard treatment for GERD. But they’re not used as often now. “They’re perfectly good medicines,” says J. Patrick Waring, MD, a gastroenterologist at Digestive Healthcare of Georgia in Atlanta and a board member at the International Foundation for Functional Gastrointestinal Disorders (IFFGD.) “But H2 blockers just aren’t as powerful as the proton pump inhibitors.”
Some doctors still recommend them as GERD treatment, at least for mild cases. They’re also sometimes added to PPIs to help treat occasional breakthrough symptoms. Cheskin tells WebMD that H2 blockers may have one significant advantage. Because most are generic, they can be less expensive than PPIs.

Antacids. The old standbys from your grandparents’ medicine cabinet — tablets like Tums and Rolaids and liquids like Maalox and Mylanta — can still play a role in controlling GERD. These heartburn remedies aren’t suited for regular, long-term use. But their main advantage is that they work quickly, unlike more powerful GERD medications.
“If you’re suffering with heartburn after drinking or eating a big spicy meal, a proton pump inhibitor is not going to help,” Cheskin says. “But an antacid will.” Just as antacids offer heartburn relief to people without GERD, they can help GERD sufferers who have occasional breakthrough symptoms.

Prokinetics. These prescription drugs — like Reglan and Urecholine– help speed up the emptying of the stomach. While they’re often mentioned alongside other GERD treatments, experts say that they’re rarely helpful. They might be of benefit to people who have GERD on top of another condition that’s slowing down their digestion. At the same time, prokinetics can have serious side effects.
Many potent drugs that were once only available by prescription — like H2 blockers and the PPI Prilosec — are now available over the counter. Experts say it’s fine for a person with occasional heartburn to use them, provided he or she follows the directions. Generally, they should never be used for more than two weeks.

GERD Treatments: Self-Care Tips
While drugs are often the main GERD treatment, there’s a lot you can do on your own. Here are some lifestyle tips for heartburn relief.

Avoid trigger foods. Changing your diet can yield big benefits. Classic GERD triggers include chocolate, coffee, alcohol, peppermint, citrus juices, and tomatoes. The exact food triggers vary from person to person.
GERD Treatments: Self-Care Tips continued…
The prospect of life without coffee or chocolate may seem terribly depressing. But you don’t necessarily have to give them up entirely. “It’s about how much of these foods you eat,” says Cheskin. “So you can probably still have a half cup of coffee without a problem. The trouble starts if you’re having the coffee after a spicy meal.”

Butschlick says she misses chocolate the most, but she still eats it on occasion. “I just try to keep it to a small piece,” she tells WebMD, “and I’m prepared with some Tums for afterward.”

Eat smaller meals. It’s not just what you eat, but how much. So avoid stuffing yourself. Instead of eating three big meals a day, try more frequent smaller meals.
Don’t eat before bed. Waring says you shouldn’t eat two to three hours before bed. Not eating gives your stomach time to empty before you lie down.
Loosen your belt. Tight belts or pants can aggravate your GERD symptoms. Wear looser clothing, especially at night.
Prop up the bed. When you stick blocks under the head of your bed and raise it 6 to 8 inches, gravity will prevent the acids in your stomach from flowing into the esophagus during the night. While this used to be common advice, not everyone can do it. “Sleeping on an elevated bed just isn’t very comfortable,” says Waring.
Lose weight. The heavier you are, the higher your risk of GERD. How much weight do you need to lose to control your symptoms? No one knows for sure, Rao says. But if you’re obese, aiming for a 10% weight loss is always a good idea.

Evaluate your other medications. Many common medications — aspirin and other NSAID painkillers, along with some drugs for high blood pressure — can make GERD worse. Talk to your doctor about possible alternatives that may not worsen your symptoms.
Stop smoking. Some experts believe that smoking may aggravate GERD symptoms. Add it to your list of good reasons to kick the habit.
Take your GERD medicine as prescribed. GERD symptoms may come and go, but the underlying condition remains. Once you’re feeling better, you may be tempted to stop your long-term medication. That’s not a good idea. “Even if you’re not having symptoms, the GERD could still be causing damage,” Cheskin says. “You may feel fine right up until the acid bores a hole in your esophagus.” Never stop taking your medication unless you’ve talked to your doctor.
Can lifestyle changes be a person’s onlyGERD treatment? Experts disagree. Some believe that lifestyle changes can be enough on their own; others think that they should be added to medication. Talk to your doctor about the best approach in your case.

Some people opt for lifestyle changes because they don’t like the idea of being on lifelong medication. Al Kenny, a GERD sufferer from Englewood Cliffs, N.J., says he prefers to control his GERD with a better diet instead of his PPI. But it’s hard to find the motivation.

“My medicine lets me eat almost anything, which is the good news,” Kenny says. “But the bad news is that it works so well that I’m really not too careful about what I eat. So I can’t stop taking the drug.”
GERD Treatments: Surgery
Surgery for GERD can be effective. But because PPIs control symptoms so well, Rao says, rates of GERD surgery in the U.S. are falling rapidly.

Still, some patients — Rao estimates less than 1% of all people with GERD — might need it. Experts say that candidates for GERD surgery are people who

Get some relief from medication, but still have symptoms anyway
Can’t or won’t take GERD medication
Already have complications, like Barrett’s esophagus, from GERD
Considering that the surgery does have a small risk of serious complications, it’s crucial that you get a correct diagnosis. You’ll need an endoscopy and probably other tests to make sure that you really do have GERD. To be certain, you may also want to consider a second opinion.

Finally, when finding a surgeon, choose someone with a lot of experience doing the specific operation you need. Waring recommends that he or she have a track record of at least 200 procedures.

The Importance of GERD Treatment
If you have GERD, there are a lot of effective ways you can control it. While newer, powerful over-the-counter medicines are one option, Cheskin notes a serious downside.

“These drugs provide such effective relief that there’s much less incentive for people with undiagnosed GERD to seek medical help,” says Cheskin.

That’s a problem. Self-diagnosis and self-treatment aren’t smart. If you have GERD, you need a doctor’s help. Together you can sort out the best GERD treatment — and make sure that you don’t have another condition altogether.

GERD sufferer Chuck Alkin, 75, agrees. “My advice to people is to get treatment early,” says the New York City resident. He developed GERD about 45 years ago, and more recently, Barrett’s esophagus. Now, he’s concerned about his increased risk of cancer.

“It took me 20 years to get a diagnosis, and I regret that,” Alkin says. “If I’d been diagnosed earlier, and gotten treatment, I don’t think I’d be in this situation now.”

* Some patient names have been changed by request.

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