Other Treatments

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Other options, such as the ones in the following list, are available for treatment of low back pain. These treatments may give relief for a short time, but none of them have been dependably better than placebo (inactive) treatments in speeding recovery or in preventing new episodes of back pain. These treatments may also be expensive.

• Traction
  Traction treatments use systems of weights, cables, and pulleys in an attempt to reduce pressure on the disks and the joints between the vertebrae. It was thought that such traction as well as stretching muscles and connective tissues of the back might have a beneficial effect. Careful evaluation of the available research found no evidence of benefits from traction. It has not proved effective in relieving long-term pain or in making bouts of acute low back pain shorter.
  
  
• Transcutaneous Electrical Nerve Stimulation (TENS)
  TENS is a technique in which electrode patches are placed on the skin and low-voltage electric currents are passed between them. There is no dependable evidence that TENS is beneficial in patients with acute or chronic low back pain.
  
  
• Massage
  Massage can warm and relax back muscles and improve blood flow. While gentle massages may be pleasurable, no improvements in self-rated pain were found among sufferers of acute low back pain.
  
  
• Biofeedback
  Biofeedback has been used to measure the electrical activity of back muscles and to train patients to reduce muscle activity and tension. There is no dependable evidence that biofeedback is effective for treating patients with chronic low back pain. This treatment technique has not been sufficiently studied in patients with acute low back pain to permit firm conclusions. Biofeedback may be beneficial in reducing stress. The risks of biofeedback are very low.
  
  
• Acupuncture
  In traditional Chinese acupuncture, needles are inserted into specific areas of the body. The needles are then rotated to produce a mildly irritating stimulus. Evidence that acupuncture is effective for treating patients with chronic low back pain is not dependable. Acupuncture has not been sufficiently studied in patients with acute low back pain to permit a conclusion. Acupuncture was found to have risks of complications, including bacterial and viral infections, bleeding, and nerve injury.
  
  
• Injections Into the Back
  A number of techniques of injecting various substances at various points of the back have been used in attempts to reduce low back pain. For acute back pain, none of these techniques have been shown to consistently yield better results than doing nothing. Injection techniques are invasive and may have significant associated risks, such as placement of the needle where it may do damage. Some research suggests that certain injections in the back may be useful under special conditions. Those conditions include cases in which disease processes exist in addition to back pain and the requirement that the injections be carried out by physicians who are expert in the technique.
  
  
• Back Corsets and Belts
  There is no evidence that lumbar corsets or support belts are effective for treating low back pain. Lumbar supports were not found to be effective in preventing or reducing low back pain in people who do frequent lifting at work. While wearing such belts does not appear to be harmful, the belts can be expensive and uncomfortable.
  
  
• Ultrasound
  The purpose of ultrasound treatment is to warm the deep layers of soft tissues in the back. Ultrasound does this by means of high-intensity sound waves that are outside hearing range. There is no evidence that this is beneficial in restoring normal function in back pain sufferers.
  
  
• Percutaneous Electrical Nerve Stimulation (PENS)
  PENS is a recently developed pain-relieving treatment that combines the advantages of TENS with those of electroacupuncture. Small needles similar to those used in acupuncture are placed in the soft tissue or muscles of the lower part of the back at points that correspond to the origin of the pain. The needles are then used to deliver low-intensity electrical impulses.

In a clinical trial, PENS was compared with three other treatments: TENS, exercise, and PENS without electrical pulses. All four treatments were administered for a period of 30 minutes 3 times per week for 3 weeks. According to 91% of the patients, PENS was the most effective of the four treatments in decreasing low back pain. PENS was also better at improving physical activity, quality of sleep, and sense of well-being, with greater improvement of functioning after treatment.