If you’ve ever thrown out your back, you know how excruciating and debilitating it can be. You also know how difficult it can be to treat, especially if the pain turns into a chronic problem.

At some point in their lives, about 80 percent of Americans develop back pain that’s severe enough to send them to bed for at least a day or two. In all too many cases, they go on to develop chronic back pain that can ruin their quality of life for months or even years.

So-called “usual medical care” for chronic back pain includes painkillers, anti-inflammatory drugs, muscle relaxants, and physical therapy. But this approach often doesn’t work. In many cases, all those medications not only fail to relieve the pain and restore mobility. They also cause additional problems ranging from stomach irritation to serious gastrointestinal complications such as ulcers, bleeding or even a perforation of the stomach or intestine.

So it’s no wonder that many back-pain sufferers are willing to try alternative treatments that have fewer side effects. Although most such treatments haven’t been well-studied, there’s now good evidence that massage may be better than either medication or exercise for easing low back pain.

In a study published in a recent issue of the Annals of Internal Medicine, Seattle researchers recruited 401 patients with chronic back pain and randomly assigned them to one of the three groups:

• Usual care.
• Relaxation massage.
• Structural massage, which focuses on soft-tissue abnormalities and requires more training than relaxation massage.

Participants in the usual care group continued to receive whatever care they had been receiving such as painkilling drugs, back exercises, yoga, or any other therapy except massage. Participants in the massage groups received weekly hour-long massages for 10 weeks in addition to their usual care.

The study was funded by the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health.

After 10 weeks, more than 33 percent of those in the massage groups reported that their back pain was either gone or much improved compared to only about 4 percent of the usual care group. The massage groups also spent fewer days in bed, used less anti-inflammatory medication, and engaged in more physical activity.

After six months, the group differences had decreased, but both types of massage were still associated with significantly less pain and improved function compared to usual care. After a year, however, measures of pain and function were about the same in all three groups. 

“The most interesting result from the study was that relaxation massage was as effective as structural massage,” said lead author Daniel Cherkin, PhD, director of Group Health Research Institute in Seattle. “So from a practical perspective it would be easier for people to find massage therapists who have training in relaxation massage because essentially all of them do whereas probably most don’t have advanced training in structural massage.”

Most of the study participants were white, middle-aged women with typical back pain, the kind that results from wear and tear on muscles or from sitting for long periods of time in front of a computer. Because the researchers wanted to test the effectiveness of massage for everyday back pain, they excluded those whose back pain was caused by an injury or a disease such as cancer.

Importantly, all of the participants saw a doctor for their back pain at least several months before entering the study, received usual care, and reported that they were still having significant problems.

“We found that those that got a course of massage did better than those who didn’t,” Cherkin said. “So I think for people who have not responded well to the usual treatments they receive or have had reactions or side effects from treatments like NSAIDs, massage is a reasonable treatment option.”

Because everybody’s back pain is different, Cherkin said, there’s no single treatment that works for everybody. So people should feel empowered to try a variety of different approaches until they find something that works.

Studies suggest that some people benefit from alternative treatments such as massage, chiropractic, yoga, or acupuncture while others may benefit from a type of psychotherapy called cognitive behavioral therapy.

Useful self-help therapies include ice packs, hot compresses, whirlpool baths, and physical activity ranging from prescribed exercises to daily walks.

As long as you’re not hurting yourself, evidence suggests that any kind of physical activity is beneficial, Cherkin said: “It may not be a specific exercise that is important. It may just be moving your back.”

“A lot of it is attitude,” he added. “If you can shift from the attitude that my back pain is killing me and there’s nothing I can do about it to my back pain is killing me and there’s a lot of things I can try, that’s going to be more productive for many people. It would be nice for physicians to give a list of things to people that could be helpful, like try a warm bath, try a shower massage, walk for 20 minutes, pet your dog, listen to music. There are a lot of things that can distract one from thinking about the pain and give enjoyment. I think the major problem is focusing on the pain because then it becomes a vicious circle.”

Cherkin and his colleagues also have published an online article: “Back in Action: A Guide to Understanding Back Pain and Learning What To Do About It,” which includes the following tips:

• Practice relaxation techniques (e.g., breathing exercises, self-hypnosis, meditation, music).
• Stretch gently once each hour spent sitting.
• Place a board under your mattress or put your mattress on the floor.
• Use a roll-up towel or pillow behind the small of your back when sitting at work, at home, or in the car.
• Keep blue ice or bags of peas in your freezer for use during episodes of acute pain.
• Sleep on a waterbed.
• Ask your friends with back pain what works for them.

You can find the article at http://www.grouphealthresearch.org/faculty/profiles/selfcare/bna_toc.html

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