"Back pain is dangerously overtreated"... we wrote last July in our issue, "Is Your Back Aching?"
We pointed out the problem of using medication to overtreat folks with lower-back pain... instead of finding relief through simple stretching, massage, and exercise.
I love when we get validation...
Last week, the American College of Physicians ("ACP") issued a new guideline for doctors. Their verdict: treat back pain with other therapies before writing a prescription.
The ACP evaluates hundreds of randomized, controlled trials (our gold standard for research) and makes treatment guidelines for clinicians. They're similar to another group we follow, the U.S. Preventive Services Task Force.
The new guideline states that any patient with lower-back pain should first receive a non-medication treatment. This includes things like:
- Heat treatment
We recommended three of these in our original issue. And which one works best for you can vary depending on the type of back pain you have. Acute pain lasts for shorter periods (a few days to a few months) and generally comes on fast and strong, often caused by some sort of injury. Chronic pain lasts much longer (months or years) and has many causes, including untreated acute pain.
Here's a review of some of the most recent research out there for each of these therapies...
1) Massage. ACP found that massage worked best for people suffering from chronic lower-back pain, and it does even better when combined with other therapies.
A study out last year in BMC Musculoskeletal Disorders, found that manual therapy – including stretching and massage – lowered pain intensity by 64% in 12 weeks. After a year, that number was still an impressive 58%.
Massage on its own helps relieve back pain, though there are fewer massage-only studies. An older study published in the Annals of Internal Medicine compared types of massage (structural versus relaxation) and found both provided relief to patients...
Both massage groups experienced less pain interfering with their daily living activities. What's more, these groups reported lower levels of pain and better symptom tolerability six months later as well.
I try to get a full-body massage at least once a month. And if a professional massage isn't in the budget, find a partner who will return the favor.
2) Exercise. Exercise keeps us moving and stretching. By working our core muscles especially, exercise can stabilize our spines and help relieve pain.
As I wrote before, most back pain is caused by poor posture. Strengthening the muscles around your spine can help correct that problem. That's because the muscles in your "trunk" – your abs, back muscles, even the muscles used for breathing – all keep your spine in proper alignment.
In fact, a new study out of the Journal of Athletic Training has evidence to back it up... Researchers looked at randomized, controlled studies for both general exercise workouts and specific, core-strengthening workouts. The core-strengthening group experienced better reduction in pain intensity and improved functional ability.
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3) Meditation. Meditation is one of my favorite therapies. It's simple, effective, and anyone can do it. It helps lower blood pressure, reduce stress, and alleviate back pain.
Researchers from the University of Pittsburgh evaluated folks 65 and over who had chronic lower-back pain. They randomized them into a meditation group or a control group. Those in the meditation group practiced meditation for about 30 minutes a day, four times a week for eight weeks. Those in the meditation group experienced significant improvement in their physical function as well as pain levels.
Do what I do and add a breathing routine to your meditation. Simple "combat breathing" helps stimulate the relaxation response and also helps focus your respiratory muscles... meaning it improves your posture, as we explained above.
To incorporate combat breathing, simply:
- Breathe in for a count of four.
- Hold your breath for a count of four.
- Exhale for a count of four.
- Count to four before starting over again.
4) Heat treatment. Several studies show that heat wraps can help relieve lower-back pain, at least in the short term and for more acute pain.
One study from the journal Spine demonstrated this with a randomized trial at three different medical facilities. They found a combination of exercise with heat-wrap therapy worked best... In fact, those in the heat-and-exercise group had 175% more improvement in back function than people in the control group (who only received a booklet on pain management).
Note that this study, along with many others, highlights the importance of combining these therapies for the best results.
My advice... get out there and move. Stretch, exercise, and massage out the sore muscles. Adding heat wraps and taking time to meditate will do wonders for your health, not only for your aching back, but for your overall well-being.
If these treatments don't work, your back pain may require medication. If so, first talk with your doctor about opting for an anti-inflammatory like acetaminophen. Opioids are too often overprescribed and carry dangerous side effects (including a high risk of addiction), so use those as a last resort.
What We're Reading...
- You can read the full back-pain treatment guidelines here.
- Something different: The history behind Presidents' Day weekend.
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Retirement Millionaire Daily Research Team
Buffalo, New York
February 21, 2017