What is the evidence on use of alternative treatments for low back pain?

The Bottom line: Cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are among the therapies with good evidence of moderate efficacy for chronic or subacute low back pain. For acute, superficial heat is the only therapy with good evidence of efficacy.

Chou, Roger Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine 2007 vol:147 iss:7 pg:492 -504

Many nonpharmacologic therapies are available for treatment of low back pain. One study reported 65% of primary care clinicians recommended massage therapy; 55% therapeutic ultrasonography; and 22% recommended, prescribed, or performed spinal manipulation. Another study found 38% of patients with spine disorders were referred to a physical therapist for physical therapy or other interventions. Benefits of nonpharmacologic therapies over placebo, sham therapy, or no treatment averaged 10 to 20 points on a 100-point visual analogue pain scale, 2 to 4 points on the Roland–Morris Disability Questionnaire.

Appendix Table 6. Systematic Reviews of Efficacy of Nonpharmacologic Therapies for Low Back Pain Page W-127

Appendix Table 8. Additional, Large Trials of Acupuncture, Exercise, and Spinal Manipulation for Low Back Pain Not Included in Systematic Reviews Page W-136

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