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Low Back Pain

Also indexed as: Back Strain, Backache, Herniated Disc, LBP, Sciatica, Slipped Disc

Illustration

Get real relief from low back pain. Strengthen your lower back with regular exercise and good nutrition. According to research or other evidence, the following self-care steps may be helpful:

What you need to know

  • Take care of your back
  • Practice good workplace and lifestyle habits, such as lifting and standing properly; learn proper exercises to reduce low back pain from a qualified instructor
  • Try an enzyme preparation
  • Take 4 to 8 tablets a day of proteolytic enzymes containing trypsin, chymotrypsin, and/or bromelain to control inflammation
  • Try B vitamins
  • Take vitamins B1 (150 mg a day), B6 (150 mg a day), and B12 (250 mcg a day) so you need less anti-inflammatory medication, and to help you prevent relapses of low back pain
  • Consider seeing a chiropractor
  • A qualified practitioner may be able to help correct spinal problems that contribute to back pain and disability
  • Get a checkup
  • See your healthcare provider to make sure your symptoms are not related to a medical problem
  • Quit smoking
  • Smokers suffer more low back pain, probably due to reduced nutrition to spinal discs

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full low back pain article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About low back pain

The low back supports most of the body’s weight, and as a result, is susceptible to pain caused by injury or other problems. Over 80% of adults experience low back pain (LBP) sometime during their life.1 More than half will have a repeat episode.

It is often difficult to pinpoint the root of low back pain, though poor muscle tone, joint problems, and torn muscles or ligaments are common causes. A herniated or slipped disc may also cause low back pain as well as sciatica, a condition where pain travels down one or both buttocks and/or legs.

Standing or sitting for extended periods, wearing high heels, and being sedentary increase the risk of developing low back pain, as do obesity and back strain due to improper lifting. Up to half of pregnant women experience some low back pain.2 Long hours spent driving a car may contribute to a herniated disc.3 This is possibly due to the vibration caused by the car.4

Many people with low back pain recover without seeing a doctor or receiving treatment. Up to 90% recuperate within three to four weeks,5 though recurrences are common,6 7 8 and chronic low back pain develops in many people.9 Low back pain is considered acute, or short-term, when it lasts for a few days up to many weeks. Chronic low back pain refers to any episode that lasts longer than three months.

While low back pain is rarely life threatening, it is still important to have chronic or recurring back pain assessed by a healthcare professional. Potentially serious causes include spinal tumor, infection, fracture, nerve damage, osteoporosis, arthritis, or pain caused by conditions found in internal organs such as the kidneys.

Product ratings for low back pain

Science Ratings Nutritional Supplements Herbs
3Stars

Enzymes (chymotrypsin, trypsin)

 
2Stars

D,L-phenylalanine (DLPA)

Vitamin B1, Vitamin B6, Vitamin B12 (in combination)

Colchicine (from autumn crocus)

Willow

1Star

Bromelain

Enzymes (papain)

Vitamin C

Cayenne (topical)

Devil’s claw

Eucalyptus (topical)

Ginger

Peppermint (topical)

Turmeric

See also:  Homeopathic Remedies for Low Back Pain
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Low back pain may be a steady ache or a sharp, acute pain that is worse with movement.

Medical options

Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin®, Advil®), and naproxen (Aleve®), may help provide pain relief in mild cases. Individuals with low back pain due to strained muscles might benefit from topical application of methylsalicylate (Ben-Gay®, Icy Hot®, Flexall Ultra Plus®) or trolamine salicylate (Aspercreme®, Myoflex®).

Prescription strength NSAIDs, such as celecoxib (Celebrex®), valdecoxib (Bextra®), ibuprofen (Motrin®), naproxen (Naprosyn®, Anaprox®), indomethacin (Indocin®), diclofenac (Voltaren®), and etodolac (Lodine®), might be necessary. Moderate to severe pain might require the use of narcotics combined with acetaminophen, such as codeine (Tylenol® with Codeine), hydrocodone (Vicodin®, Lortab®), and oxycodone (Percocet®). Muscle relaxants, such as carisoprodol (Soma®), cyclobenzaprine (Flexeril®), and baclofen (Lioresal®), might be prescribed.

Hot and cold application, rest, strengthening and flexibility exercises, physical therapy, and instruction on good posture and body mechanics may be included in a conventional treatment plan. In some cases, back surgery may be recommended.

Lifestyle changes that may be helpful

Preliminary data indicate that smoking may contribute to low back pain.10 One survey of over 29,000 people reported a significant association between smoking and low back pain.11 Smaller people (children, women, those who weigh less) are most affected. A study involving people with herniated discs found that both current and ex-smokers are at much higher risk of developing disc disease than nonsmokers.12 Other research reveals 18% greater disc degeneration in the lower spines of smokers compared with nonsmokers.13 Smoking is thought to cause malnutrition of spinal discs, which in turn makes them more vulnerable to mechanical stress.14

One survey reported that people who drank wine healed more quickly after disc surgery in the lower back than those who abstained.15 However, alcohol consumption may cause cirrhosis of the liver, cancer, high blood pressure, and alcoholism. As a result, many doctors never recommend alcohol even though moderate consumption has been linked to some health benefits. For those deciding whether light drinking might help with recovery from disc surgery, it is best to consult a doctor.

Regular exercise and proper lifting techniques help prevent low back problems from developing. Proper lifting involves keeping an object close to the body and avoiding bending forwarding, reaching, and twisting while lifting. Low back pain and disc degeneration are both more likely to develop among sedentary people than those who are physically active.16 However, long-term participation in some competitive sports may contribute to spinal disc degeneration.17

Therapeutic exercise helps people recover from low back pain18 and low back surgery.19 Less clear are details about how this should be done for greatest benefit. In other words, the best type of exercise, frequency, duration, and timing of a program still need to be determined. One study reported therapeutic exercise significantly improved chronic low back pain compared to exercise performed at home without professional guidance.20 Another trial discovered that women with chronic low back pain who began supervised back strengthening exercises at a fitness center were more consistent exercisers than those who started and continued therapeutic exercises at home.21 Both groups experienced significant improvement in pain. However, the supervised group experienced better long-term improvement.

While heavy lifting and other strenuous labor may contribute to low back pain, one trial found that people with sedentary jobs gained more benefit from an exercise program than those who have physically hard or moderate occupations.22 Motivational programs may also improve exercise consistency, which in turn decreases pain and disability.23 People with low back pain who wish to embark on an exercise program should first consult with a physical therapist or other practitioner skilled in this area.

Supervised bed rest, for two to four days, coupled with appropriate physical therapy and therapeutic exercise, is often recommended by medical doctors for acute low back pain.24 However, reviews of bed rest recommendations have concluded that bed rest is, at best, ineffective and may even delay recovery.25 26 It is better to try to stay active and maintain a normal daily schedule as much as possible.

General recommendations for people recuperating from low back pain include wearing low-heeled comfortable shoes, sitting in chairs with good lower back support, using work surfaces that are a comfortable height, resting one foot on a low stool if standing for long periods, and supporting the low back during long periods of driving.27

Vitamins that may be helpful

Three double-blind trials have investigated the effects of supplementing a combination of the enzymes trypsin and chymotrypsin for seven to ten days on severe low back pain with or without accompanying leg pain. Eight tablets per day were given initially in all trials, but in two trials the number of pills was reduced to four per day after two to three days. One of these trials reported small, though statistically significant improvements, for some measures in people with degenerative arthritis of the lower spine.28 People with sciatica-type leg pain had significant improvement in several measures in one trial,29 while another found the enzymes were not much more effective than a placebo.30 These trials included chronic low back conditions, so their relevance to acute LBP alone may be limited.

Several animal studies and some research involving humans suggest that a synthetic version of the natural amino acid phenylalanine called D-phenylalaline (DPA), reduces pain by decreasing the enzyme that breaks down endorphins.31 It is less clear whether DPA may help people with LBP, though there are a small number of reports to that effect,32 including one uncontrolled report of 27 of 37 people with LBP experiencing “good to excellent relief.”33 In a double-blind trial, University of Texas researchers found that 250 mg of DPA four times per day for four weeks was no more effective than placebo for 30 people with various types of chronic pain; 13 of these people had low back pain.34 In a Japanese clinical trial, 4 grams of DPA per day was given to people with chronic low back pain half an hour before they received acupuncture.35 Although not statistically significant, the results were good or excellent for 18 of the 30. The most common supplemental form of phenylalanine is D,L-phenylalanine (DLPA). Doctors typically recommend 1,500–2,500 mg per day of DLPA.

A combination of vitamin B1, vitamin B6, and vitamin B12 has proved useful for preventing a relapse of a common type of back pain linked to vertebral syndromes,36 as well as reducing the amount of anti-inflammatory medications needed to control back pain, according to double-blind trials.37 Typical amounts used have been 50–100 mg each of vitamins B1 and B6, and 250–500 mcg of vitamin B12, all taken three times per day.38 39 Such high amounts of vitamin B6 require supervision by a doctor.

Proteolytic enzymes, including bromelain, papain, trypsin, and chymotrypsin, may be helpful in healing minor injuries because they have anti-inflammatory activity and are capable of being absorbed from the gastrointestinal tract.40 41 42 Several preliminary trials have reported reduced pain and swelling, and/or faster healing in people with a variety of conditions who use either bromelain43 44 45 or papain.46 47 48

A preliminary report in 1964 suggested that 500–1,000 mg per day of vitamin C helped many people avoid surgery for their disc-related low back pain.49 No controlled research has been done to examine this claim further.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Colchicine, a substance derived from autumn crocus, may be helpful for chronic back pain caused by a herniated disc. A review shows that colchicine has provided relief from pain, muscle spasm, and weakness associated with disc disease50 51 including several double-blind trials.52 The author of these reports has suggested that 0.6 to 1.2 mg of colchicine per day leads to dramatic improvement in four out of ten cases of disc disease. In most clinical trials, colchicine is given intravenously.53 However, the oral administration of this herb-based remedy also has had moderate effectiveness. People with low back pain should consult a physician skilled in herbal medicines before taking colchicine due to potentially severe side effects.

Willow bark is traditionally used for pain and conditions of inflammation. According to one controlled clinical trial, use of high amounts of willow bark extract may help people with low back pain. One trial found 240 mg of salicin from a willow extract to be more effective than 120 mg of salicin or a placebo for treating exacerbations of low back pain.54

Topical cayenne pepper has been used for centuries to reduce pain, and more recently, to diminish localized pain for a number of conditions,55 including chronic pain,56 although low back pain has not been specifically investigated. Cayenne creams typically contain 0.025–0.075% capsaicin.57 While cayenne cream causes a burning sensation the first few times used, this decreases with each application. Pain relief is also enhanced with use as substance P, the compound that induces pain, is depleted.58 To avoid contamination of the mouth, nose, or eyes, hands should be thoroughly washed after use or gloves should be worn. Do not apply cayenne cream to broken skin.

One double-blind trial found that devil’s claw capsules (containing 800 mg of a concentrated extract taken three times per day) were helpful in reducing acute low back pain in some people.59 Another double-blind trial (using 200 mg or 400 mg of devil’s claw extract three times daily) achieved similar results in some people with exacerbations of chronic low back pain.60

Herbalists often use ginger to decrease inflammation and the pain associated with it, including for those with low back pain. They typically suggest 1.5 to 3 ml of ginger tincture three times per day, or 2 to 4 grams of the dried root powder two to three times per day. Some products contain a combination of curcumin and ginger. However, no research has investigated the effects of these herbs on low back pain.

A combination of eucalyptus and peppermint oil applied directly to a painful area may help. Preliminary research indicates that the counter-irritant quality of these essential oils may decrease pain and increase blood flow to afflicted regions.61 Peppermint and eucalyptus, diluted in an oil base, are usually applied several times per day, or as needed, to control pain. Plant oils that may have similar properties are rosemary, juniper, and wintergreen.

Turmeric is another herb known traditionally for its anti-inflammatory effects, a possible advantage for people suffering from low back pain. Several preliminary studies confirm that curcumin, one active ingredient in turmeric, may decrease inflammation in both humans62 and animals.63 64 In one double-blind trial, a formula containing turmeric, other herbs, and zinc significantly diminished pain for people with osteoarthritis.65 Standardized extracts containing 400 to 600 mg of curcumin per tablet or capsule are typically taken three times per day. For tinctures of turmeric, 0.5 to 1.5 ml three times per day are the usual amount.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Acupuncture may be helpful in the treatment of low back pain in some people. Case reports66 67 and numerous preliminary trials68 69 70 71 72 73 74 have described significant improvement in both acute and chronic back pain following acupuncture (or acupuncture with electrical stimulation) treatment. In a single controlled study of acute back pain, both electroacupuncture and drug therapy (acetaminophen) led to statistically significant pain reduction and improved mobility.75

Several controlled clinical trials have evaluated acupuncture for chronic low back pain. A controlled trial found acupuncture was significantly superior to placebo (fake electrical stimulation through the skin) in four of five measures of pain and physical signs.76 Controlled trials using electroacupuncture have reported either benefit77 or no benefit78 for chronic back pain. A double-blind trial compared acupuncture to injections of anesthetic just below the skin at non-acupuncture points, and found no difference in effect between the two treatments.79 Controlled trials have compared acupuncture to transcutaneous nerve stimulation (TENS). Some,80 81 though not all,82 demonstrated greater pain relief with acupuncture when compared to TENS, and one found improved spinal mobility only with acupuncture.83

In one preliminary trial, acupuncture relieved pain and diminished disability in the low back during pregnancy better than physiotherapy.84

A recent analysis and review of studies reported acupuncture was effective for low back pain,85 though another recent review concluded acupuncture could not be recommended due to the poor quality of the research.86 A third review concluded that acupuncture was beneficial for people with slipped discs and sciatica and could be recommended at the very least as a supplementary therapy.87 Since the vast majority of controlled acupuncture research addresses chronic low back pain, it remains unknown whether people with acute low back pain benefit significantly from acupuncture.88

The federally funded Agency for Health Care Policy and Research has deemed spinal manipulation effective for acute low back pain during the first month following injury.89 This recommendation is supported by other research, though some has not been well controlled.90 91 People whose initial pain or disability is severe to moderate appear to benefit the most, though those with longer lasting or chronic pain may also be helped by spinal manipulation.92 93 One 12-month controlled study found no difference in benefit between manipulation and standard physical therapy.94 Another controlled study found a series of eight treatments with spinal manipulation was as effective as conventional medical therapy, but the manipulation group needed less pain medication and physical therapy.95 Practitioners who perform spinal manipulation include chiropractors, some osteopaths, and some physical therapists.

Some researchers suggest that spinal manipulation should not be performed on people with a herniated (slipped) disc, because it may lead to spinal cord injuries.96 However, other preliminary trials report that spinal manipulation helps those with herniated discs,97 98 99 100 as did one controlled study comparing manipulation to standard physical therapy.101 In one investigation of 59 people with slipped discs who received chiropractic treatment, including manipulation, 90% reported improvement.102 Those with a history of low back surgery had poor outcomes. People with LBP due to herniated discs who wish to try this method should first consult with a chiropractor or other physician skilled in spinal manipulation. A recent controlled study compared manipulation, acupuncture, and medication for chronic spinal pain. Only manipulation significantly improved pain and disability scores.103

There is inconclusive evidence that massage alone helps people with low back pain, though preliminary research indicates it has potential.104 Many practitioners use massage in combination with other physical therapies, such as spinal manipulation or therapeutic exercise. People with low back pain who want to try massage should consult with a qualified massage therapist.

Some controlled trials indicate that biofeedback benefits people with chronic low back pain,105 106 but other trials do not.107 108 One study found that biofeedback was more effective than behavioral therapy or conservative medical treatment for people with chronic back pain. The study also found biofeedback to be the only method where people experienced significant reduction in pain for up to the two years of follow-up.109 People wishing to try biofeedback should discuss this method with a qualified practitioner.

Emotional distress has been associated with aggravating low back pain,110 including that caused by a herniated disc.111 The effects on back pain of counseling aimed at reducing emotional stress remain unknown, though it is used in some clinics employing multidisciplinary approaches to treating chronic lower back pain.

References:

1. Cassidy JD, Carroll LJ, Cote P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine 1998;23:1860–6.

2. Cohen KB. Pregnancy and low back pain. California Chiropractic Journal 1989;November:43–7.

3. Kelsey JL, Githens PB, O’Conner T, et al. Acute prolapsed lumbar intervertebral disc. An epidemiologic study with special reference to driving automobiles and cigarette smoking. Spine 1984;9:608–13.

4. Frymoyer JW. Lumbar disk disease: epidemiology. Instr Course Lect 1992;41:217–23 [review].

5. Andersson GBJ. Diagnostic considerations in patients with back pain. Phys Med Rehabil Clin N Am 1998;9:309–22.

6. Smedley J, Inskip H, Cooper C, et al. Natural history of low back pain. A longitudinal study in nurses. Spine 1998;23:2422–6.

7. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 1998;23:1875–83.

8. MacDonald MJ, Sorock GS, Volinn E, et al. A descriptive study of recurrent low back pain claims. J Occup Environ Med 1997;39:35–43.

9. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662–7.

10. Leboeuf-Yde C, Yashin A. Smoking and low back pain: is the association real? J Manipulative Physiol Ther 1995;18:457–63 [review].

11. Leboeuf-Yde C, Kyvik KO, Bruun NH. Low back pain and lifestyle. Part 1: Smoking. Information from a population-based sample of 29,424 twins. Spine 1998;23:2207–13.

12. An HS, Silveri CP, Simpson JM, et al. Comparison of smoking habits between patients with surgically confirmed herniated lumbar and cervical disc disease and controls. J Spinal Disord 1994;7:369–73.

13. Battie MC, Videman T, Gill K, et al. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine 1991;16:1015–21.

14. Ernst E. Smoking is a risk factor for spinal diseases. Hypothesis of the pathomechanism. Wien Klin Wochenschr 1992;104:626–30 [in German, review].

15. Rasmussen C. Lumbar disc herniation: favourable outcome associated with intake of wine. Eur Spine J 1998;7:24–8.

16. Salminen JJ, Erkintalo M, Laine M, Pentti J. Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine 1995;20:2101–7.

17. Videman T, Battie MC, Gibbons LE, et al. Lifetime exercise and disk degeneration: an MRI study of monozygotic twins. Med Sci Sports Exerc 1997;29:1350–6.

18. Campello M. Nordin M. Weiser S. Physical exercise and low back pain. Scand J Med Sci Sports 1996;6:63–72 [review].

19. Manniche C. Assessment and exercise in low back pain. With special reference to the management of pain and disability following first time lumbar disc surgery. Dan Med Bull 1995;42:301–13 [review].

20. Torstensen TA, Ljunggren AE, Meen HD, et al. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. Spine 1998;23:2616–24.

21. Bentsen H, Lindgarde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a 3-year follow-up period. Spine 1997;22:1494–500.

22. Hansen FR, Bendix T, Skov P, et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine 1993;18:98–108.

23. Friedrich M, Gittler G, Halberstadt Y, et al. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998;79:475–87.

24. Rosen NB, Hoffberg HJ. Conservative management of low back pain. Phys Med Rehabil Clin N Am 1998;9:435–64.

25. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997;47:647–52.

26. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229–33 [review].

27. Agency for Health Care Policy and Research. Understanding acute low back problems (patient guide). Rockville, MD: US Dept of Health and Human Services, 1994, 10.

28. Hingorani K. Oral enzyme therapy in severe back pain. Br J Clin Pract 1968;22:209–10.

29. Gaspardy G, Balint G, Mitsuova M, et al. Treatment of sciatica due to intervertebral disc herniation with Chymoral tablets. Rheum Phys Med 1971;11:14–9.

30. Gibson T, Dilke TFW, Grahame R. Chymoral in the treatment of lumbar disc prolapse. Rheumatol Rehabil 1975;14:186–90.

31. Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res 1985;192:363–70 [review].

32. Balagot RC, Ehrenpreis S, Kubota K, Greenberg J. Advances in Pain Research and Therapy, Vol 5, Bonica JJ, Liebsekind JC, Albe-Fessard DG (eds), Raven Press, New York, 1983, 289–93.

33. Gaby AR. Editor’s Corner. Northwest Acad Prev Med 1983;July:3, 5, 8.

34. Walsh NE, Ramamurthy S, Schoenfeld L, Hoffman J. Analgesic effectiveness of d-phenylalanine in chronic pain patients. Arch Phys Med Rehabil 1986;67:436–9.

35. Kitade T, Odahara Y, Shinohara S, et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (2nd report)—schedule of administration and clinical effects in low back pain and tooth extraction. Acupunct Electrother Res 1990;15:121–35.

36. Schwieger G, Karl H, Schonhaber E. Relapse prevention of painful vertebral syndromes in follow-up treatment with a combination of vitamins B1, B6, and B12. Ann NY Acad Sci 1990;585:54–62.

37. Kuhlwein A, Meyer HJ, Koehler CO. Reduced diclofenac administration by B vitamins: results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klin Wochenschr 1990;68:107–15 [in German].

38. Bruggemann G, Koehler CO, Koch EM. Results of a double-blind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr 1990;68:116–20 [in German].

39. Vetter G, Bruggemann G, Lettko M, et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol 1988;47:351–62 [in German].

40. Seligman B. Bromelain: An anti-inflammatory agent. Angiology 1962;13:508–10.

41. Castell JV, Friedrich G, Kuhn CS, et al. Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol 1997;273:G139–46.

42. Miller JM. Absorption of orally introduced proteolytic enzymes. Clin Med 1968;75:35–42 [review].

43. Masson M. Bromelain in the treatment of blunt injuries to the musculoskeletal system. A case observation study by an orthopedic surgeon in private practice. Fortschr Med 1995;113(19):303–6.

44. Miller JN, Ginsberg M, McElfatrick GC, et al. The administration of bromelain orally in the treatment of inflammation and edema. Exp Med Surg 1964;22:293–9.

45. Cirelli MG. Five years experience with bromelains in therapy of edema and inflammation in postoperative tissue reaction, skin infections and trauma. Clin Med 1967;74:55–9.

46. Vallis C, Lund M. Effect of treatment with Carica papaya on resolution of edema and ecchymosis following rhinoplasty. Curr Ther Res 1969;11:356–9.

47. Trickett P. Proteolytic enzymes in treatment of athletic injuries. Appl Ther 1964;6:647–52.

48. Sweeny FJ. Treatment of athletic injuries with an oral proteolytic enzyme. Med Times 1963:91:765.

49. Greenwood J. Optimum vitamin C intake as a factor in the preservation of disc integrity. Med Ann District of Columbia 1964;33:274–6.

50. Rask MR. Colchicine and disk disease. JAMA 1986;255:2447 [letter/review].

51. Rask MR. Colchicine use in 6000 patients with disk disease and other related resistantly-painful spinal disorders. J Neurol Orthopaed Med Surg 1989;10:291–8.

52. Rask MR. Colchicine use in five hundred patients with disk disease. J Neurol Orth Surg 1980;1(5):1–19.

53. Simmons JW, Harris WP, Koulisis CW, et al. Intravenous colchicine for low back pain: A double blind study. Spine 1990;15:716–7.

54. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: A randomized double-blind study. Am J Med 2000;109:9–14.

55. Fusco BM, Giacovazzo M. Peppers and pain. The promise of capsaicin. Drugs 1997;53:909–14 [review].

56. Schnitzer TJ. Non-NSAID pharmacologic treatment options for the management of chronic pain. Am J Med 1998;105:45S–52S [review].

57. Siften DW (ed). Physicians’ Desk Reference for Nonprescription Drugs. Montvale, NJ: Medical Economics, 1998, 790–1.

58. Rumsfield JA, West DP. Topical capsaicin in dermatologic and peripheral pain disorders. DICP 1991;25:381–7 [review].

59. Chrubasik S, Zimpfer C, Schutt U, Ziegler R. Effectiveness of Harpagophytum procumbens in treatment of acute low back pain. Phytomed 1996;3:1–10.

60. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anesthesiology 1999;16:118–29.

61. Hong CZ, Shellock FG. Effects of a topically applied counterirritant (Eucalyptamint) on cutaneous blood flow and on skin and muscle temperatures. A placebo-controlled study. Am J Phys Med Rehabil 1991;70:29–33.

62. Satoskar RR, Shah SJ, Shenoy SG. Evaluation of antiinflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. Int J Clin Pharmacol Ther Toxicol 1986;24:651–4.

63. Ghatak N, Basu N. Sodium curcuminate as an effective anti-inflammatory agent. Indian J Exp Biol 1972;10:235–6.

64. Chandra D, Gupta SS. Anti-inflammatory and anti-arthritic activity of volatile oil of curcuma longa (Haldi). Indian J Med Res 1972;60:138–42.

65. Kulkarni RR, Patki PS, Jog VP, et al. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol 1991;33:91–5.

66. Lu J. J Tradit Chin Med The clinical application of yanglingquan (GB 34) point. 1993;13:179–81.

67. Shen X. Acupuncture treatment for kidney deficiency with combined application of points mingmen and guanyuan. J Tradit Chin Med 1996;16:275–7.

68. Sun LY.Efficacy of acupuncture in treating 100 cases of lumbago. J Tradit Chin Med 1987;7:23–4.

69. Wang YY. Electro-acupuncture treatment of 55 cases of soft tissue lumbar pain. J Tradit Chin Med 1987;7:72.

70. Weiss SL. Acupuncture in low back pain. Med Times 1975;103:137–9, 144–6.

71. Wilber MC.Sedation of active acupuncture loci in the management of low back pain. Am J Chin Med 1975;3:275–9.

72. Leung PC. Treatment of low back pain with acupuncture. Am J Chin Med 1979; 7:372–8.

73. MacPherson H, Gould AJ, Fitter M. Acupuncture for low back pain: results of a pilot study for a randomized controlled trial. Complement Ther Med 1999;7:83–90.

74. Junnila SY. Long-term treatment of chronic pain with acupuncture. Part I. Acupunct Electrother Res 1987;12:23–36.

75. Hackett GI, Seddon D, Kaminski D.Electroacupuncture compared with paracetamol for acute low back pain. Practitioner 1988;232:163–4.

76. Macdonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Ann R Coll Surg Engl 1983;65:44–6.

77. Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand 1994;38:63–9.

78. Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Can Anaesth Soc J 1976;23:303–6.

79. Mendelson G, Selwood TS, Kranz H, et al. Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. Am J Med 1983;74:49–55.

80. Lehmann TR, Russell DW, Spratt KF, et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patientsPain 1986;26:277–90.

81. Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbalgia and ischialgia. Am J Chin Med 1976;4:169–75.

82. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 1999;82:9–13.

83. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 1999;82:9–13.

84. Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand 2000;79:331–5.

85. Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med 1998;158:2235–41.

86. van Tulder MW, Cherkin DC, Berman B, et al. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 1999;24:1113–23.

87. Longworth W, McCarthy PW. A review of research on acupuncture for the treatment of lumbar disc protrusions and associated neurological symptomatology. J Altern Complement Med 1997;3:55–76 [review].

88. Bigos SJ (chair). Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14. Rockville, MD: U.S. Department of Health and Human Services, 1994, 49–50 [review].

89. Bigos SJ, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14. AHCPR Publication No. 95–0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, December 1994, 34–6 [review].

90. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996;21;2860–71 [review].

91. Verhoef MJ, Page SA, Waddell SC. The Chiropractic Outcome Study: pain, functional ability and satisfaction with care. J Manipulative Physiol Ther 1997;20:235–40.

92. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine 1996;21:2860–71 [review].

93. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128–56.

94. Skargren EI, Carlsson PG, Oberg BE. One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization. Spine 1998;23:1875–83.

95. Andersson GBJ, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 1999;341:1426–31.

96. Powell FC, Hanigan WC, Olivero WC. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993;33:73–8 [review].

97. Ye RB, Zhou JX, Gan MX. Clinical and CT analysis of 35 cases of lumbar disc herniation before and after non-operative treatment. Chung His I Chieh Ho Tsa Chih 1990;10:667–8645 [in Chinese].

98. Anonymous. Manipulation for sciatica: promising results. The BackLetter 1998;13:122, 125.

99. Kuo PP, Loh Z. Treatment of lumbar intervertebral disc protrusions by manipulation. Clin Orthop Rel Res 1987;215:47–55.

100. Chrisman D, Mittnacht A, Snook GA. A study of the results following rotatory manipulation in the lumbar intervertebral disc syndrome. J Bone Joint Surg 1964;46A:517–24.

101. Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982;61:273–8.

102. Stern PJ, Cote P, Cassidy JD. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. J Manipulative Physiol 1995;18:335–42.

103. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther 1999;22:376–81.

104. Ernst E. Massage therapy for low back pain: a systematic review. J Pain Symptom Manage 1999;17:65–9 [review].

105. Vlaeyen JW, Haazen IW, Schuerman JA, et al. Behavioural rehabilitation of chronic low back pain: comparison of an operant treatment, an operant-cognitive treatment and an operant-respondent treatment. Br J Clin Psychol 1995;34:95–118.

106. Newton-John TR, Spence SH, Schotte D. Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain. Behav Res Ther 1995;33:691–7.

107. Bush C, Ditto B, Feuerstein M. A controlled evaluation of paraspinal EMG biofeedback in the treatment of chronic low back pain. Health Psychol 1985;4:307–21.

108. Stuckey SJ, Jacobs A, Goldfarb J. EMG biofeedback training, relaxation training, and placebo for the relief of chronic back pain. Percept Mot Skills 1986;63:1023–36.

109. Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol 1993;61:653–8.

110. Thomas E, Silman AJ, Croft PR, et al. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662–7.

111. Heliovaara M, Knekt P, Aromaa A. Incidence and risk factors of herniated lumbar intervertebral disc or sciatica leading to hospitalization. J Chronic Dis 1987;40:251–8.

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