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Chiropractic Research Review

Nonsurgical Approaches to Treating Low Back Pain

Wide variations in back care suggest that there is professional uncertainty about an optimal approach for relieving patient suffering. A new commentary by noted experts says that surgery is overused in the treatment of low back pain (LBP), and that there is evidence of excessive utilization of imaging in the diagnosis of LBP.

Since most patients experience a fairly rapid recovery from nonspecific LBP, this may partly explain the proliferation of treatments that may seem to be effective.

The authors state that the use of plain radiography should be limited to patients with clinical findings suggestive of underlying systemic disease.

The study notes that MRIs and surgery are overused and recommends that they be considered only in case of severe nerve pain or loss of function. Advanced imaging (CT and MRI) should be reserved for patients suspected of infection, cancer, or persistent neurologic deficit.

Bed rest is not recommended for the treatment of low back pain or sciatica. A rapid return to normal activities is not useful for the acute phase, but helps to prevent recurrences and treat chronic pain. Surgery is only appropriate for a small proportion of patients with low back symptoms. Intensive strengthening exercise and aerobics conditioning work best to minimize recurrence of chronic low back pain.

The author recommends the following treatments as potential nonmedical approaches to managing different forms of LBP:

* massage therapy;
* chiropractic care;
* aerobic conditioning;
* intensive strengthening exercise.

Deyo R, Weinstein J. Low back pain. The New England Journal of Medicine 2001:344(5), pp. 363-369.

Chiropractic Research Review

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