Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Acupuncture, CBT, stress reduction, yoga offer a small benefit for chronic back pain
Clinical Question
Are cognitive or mind-body therapies effective for treating chronic low back pain?
Bottom line
Cognitive behavioral therapy, mindfulness-based stress reduction, yoga, and acupuncture each have a small benefit to increase function and reduce pain when added to usual care of patients with chronic low back pain. Studies in patients with neck pain are inconclusive. Not everyone will be helped, but the costs are low. The available research is not robust enough to rank the therapies, so patients can decide whether they want to talk, meditate, contort, or be needled. 1a-
Reference
Study design: Systematic review
Funding: Self-funded or unfunded
Setting: Other
Synopsis
This is a summary of the evidence report created by the Institute for Clinical and Economic review (JAMA Intern Med 2018;178(4):556-557), which in turn was based on an exhaustive review of noninvasive interventions for low back pain conducted by the Agency for Healthcare Research and Quality. The group analyzed data from 28 randomized clinical trials of the treatments as compared with usual care, sham treatment, or another active treatment. For each treatment approach the authors estimated the likely net benefit, the level of certainty (based on the data quality), and cost-effectiveness. For acupuncture, cognitive behavioral therapy, mindfulness-based stress reduction, and yoga, they concluded that each is comparable with or better than usual care alone, with a moderate level of certainty that there is a small net health benefit. All of these approaches were considered to be moderate- to high-value interventions, given their low cost per quality-adjusted life year. It's hard to rank these interventions based on their relative benefit because the quality of each study may have affected the outcomes at least as much as the intervention itself. Tai chi was also included in the analysis but with only 2, fair-quality trials for treatment of low back pain and 1 small trial of treatment for neck pain, the researchers were unable to draw conclusions.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Will be useful in validating scientifically what is known empirically - these mind-body interventions ARE helpful, but like any “medicine”, they have to be used regularly / daily, and forever. Patients need to commit to permanent lifestyle changes. Benefits accrued over time - QoL significantly improves the longer each is used, and combinations are also superior to just one intervention.
Love the reviewer's wry sense of humour. Must be related to Mark Twain. Thanks for starting off my day with a smile and increasing my confidence in advising patients that there are "million" different things to do about chronic back pain because "all of them work" while at the same time "none of them work". I try to tease out what the patients feel will work best for them then advise they "go for it". The whole idea is to take advantage of the placebo effect in the most meaningful way. This review satisfies me I am on the right track here.
Basically useless information.
Nothing really works for this type of pain
Any positive results are placebo effect.
I’m pleased to see, finally, this exhaustive review of low cost noninvasive therapies. On the other hand CBT with its high cost and unavailability seems to be in a different league, don’t you think
I can provide relief in five minutes to patients who suffer from chronic low back pain. The exercises I teach them allows them to relieve their own pain whenever it recurs. You can do the same, check out https://www.youtube.com/watch?v=NXNS6PNKRPo
If you go back to the original analysis in 2017 (reference #1), there was little if any difference between sham and actual acupuncture and the conclusion is that this was likely a placebo response. This should have been presented in this review.
I agree, its useful to chronic back pain patients, some of our patients have given the same feedback after utilising interventions mainly CBT and acupuncture.
However, its their coverage which is a concern for our patient group, generally speaking.
I'm not sure I'd characterize many of these interventions as "low cost." Certainly not when compared to the cost of a visit to the family doctor's office.
good poem
Would like to see more, better-quality studies on these alternate modalities for pain relief. Particularly interested in any studies on the benefits of individualized core training programs for relief of chronic back pain.