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Low-Back Pain and Complementary Health Approaches: What You Need To Know

low back pain

What’s the Bottom Line?

What do we know about the effectiveness of complementary health approaches for low-back pain?

  • There’s low- or moderate-quality evidence that a variety of mind and body practices, including acupuncture, electromyography biofeedback, low-level laser therapy, mindfulness-based stress reduction, progressive muscle relaxation, spinal manipulation, tai chi, and yoga, may be helpful for chronic low-back pain.
  • There’s low-quality evidence that acupuncture, massage therapy, and spinal manipulation may be helpful for acute low-back pain.
  • Preparations of the herb cayenne, used topically, may help to relieve low-back pain.

What do we know about the safety of complementary health approaches for low-back pain?

  • The mind and body practices mentioned above (acupuncture, electromyography biofeedback, low-level laser therapy, massage therapy, mindfulness-based stress reduction, progressive muscle relaxation, spinal manipulation, tai chi, and yoga) have good safety records when used appropriately. However, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches.
  • If you’re considering natural products such as oral or topical herbal products, remember that natural doesn’t always mean safe and that some natural products may have side effects or interact with medications.

Some Basics About Low-Back Pain

Low-back pain is a very common problem in the United States and around the world. About 80 percent of adults have low-back pain at some point in their lives. It’s the most common cause of job-related disability and a leading contributor to missed work days and visits to physicians.

Most episodes of low-back pain last only a short period of time. Health professionals call this acute low-back pain. Acute low-back pain is often defined as pain that lasts for up to 4 weeks. In most cases, acute low-back pain goes away without causing any lasting problems.

Low-back pain that lasts for between 4 and 12 weeks is called subacute.

If low-back pain lasts for 12 weeks or longer, it’s called chronic. Treatment sometimes relieves chronic low-back pain successfully, but in other cases, pain persists despite treatment.

Clinical Practice Guidelines for Treating Low-Back Pain

Clinical practice guidelines provide recommendations, developed by groups of experts, to help health care providers and patients make informed decisions about what types of care to use. They’re based on reviews of the scientific evidence and assessments of the potential benefits and harms of different care options. The guidelines are updated frequently as new evidence becomes available.

The American College of Physicians issued a clinical practice guideline for the treatment of low-back pain in 2017. The guideline recommends that health care providers and patients use nondrug treatments as first-line therapy for chronic low-back pain. It also recommends the use of nondrug approaches for acute low-back pain, with or without drug therapy. Several complementary health approaches are among the treatment options suggested for acute low-back pain, chronic low-back pain, or both.

What the Science Says About Complementary Health Approaches for Low-Back Pain

Mind and Body Approaches:

Natural Products

NCCIH-Funded Research

The National Center for Complementary and Integrative Health (NCCIH) is collaborating with other agencies to fund 11 large-scale studies on the implementation of nondrug approaches for pain management in the military and veterans health care systems. Several of these studies focus specifically on low-back pain.

NCCIH is participating in the National Institutes of Health (NIH) HEAL (Helping to End Addiction Long-termSM) Initiative—an effort to find new ways to address the national public health crisis related to opioids. HEAL includes the NIH Back Pain Research Consortium (NIH BACPAC), which will address the need for better therapies for low-back pain, and the PRISM (Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing) program, which will fund several studies, including a study of acupuncture for chronic low-back pain in older adults.

Other NCCIH-funded studies are addressing a variety of complementary health approaches for back pain, including

  • Mindfulness-based dance/movement therapy for low-back pain
  • Tai chi for chronic low-back pain in older adults
  • The mechanisms of psychosocial treatments for chronic low-back pain.

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

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To provide resources that help answer health questions, MedlinePlus (a service of the National Library of Medicine) brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.

Information on back pain


Key References

Other References

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NCCIH thanks David Shurtleff, Ph.D., NCCIH, for his review of and contributions to this publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: January 2020