1) Acupunc­ture
A study con­ducted at Sheffield Uni­ver­sity in the United King­dom looked at the long-term symp­tom reduc­tion and eco­nomic ben­e­fits of acupunc­ture for per­sis­tent low back pain. An aver­age of 8 acupunc­ture treat­ments were given to 159 peo­ple, while 80 peo­ple received usual care instead.

After one year, peo­ple receiv­ing acupunc­ture had reduced pain and reported a sig­nif­i­cant reduc­tion in worry about their pain com­pared to the usual care group. After two years, the acupunc­ture group was sig­nif­i­cantly more likely to report that the past year had been pain-free. They were less likely to use med­ica­tion for pain relief.

How does acupunc­ture work? Accord­ing to tra­di­tional Chi­nese med­i­cine, pain results from blocked energy along energy path­ways of the body, which are unblocked when acupunc­ture nee­dles are inserted along these invis­i­ble pathways.

A sci­en­tific expla­na­tion is that acupunc­ture releases nat­ural pain-relieving opi­oids, sends sig­nals that calm the sym­pa­thetic ner­vous sys­tem, and releases neu­ro­chem­i­cals and hormones.

An acupunc­ture treat­ment gen­er­ally costs between $60 and $120. Acupunc­ture is tax-deductible (it’s con­sid­ered a med­ical expense) and some insur­ance plans pay for acupuncture.

If you want to try acupunc­ture, plan on going one to three times a week for sev­eral weeks initially.

2) Cap­saicin Cream
Although you may not have heard of cap­saicin (pro­nounced cap-SAY-sin) before, if you’ve ever eaten a chili pep­per and felt your mouth burn, you know exactly what cap­saicin does. Cap­saicin is the active ingre­di­ent in chili peppers.

When it is applied to the skin, cap­saicin has been found to deplete sub­stance P–a neu­ro­chem­i­cal that trans­mits pain–causing an anal­gesic effect.

In one double-blind study, 160 peo­ple were treated with cap­saicin for 3 weeks, while another 160 peo­ple used a placebo. After 3 weeks, pain was reduced by 42% in the cap­saicin group com­pared to 31% in the placebo group. Inves­ti­ga­tors rated cap­saicin sig­nif­i­cantly more effec­tive than placebo.

Cap­saicin cream, also called cap­sicum cream, is avail­able in drug stores, health food stores, and online. A typ­i­cal dosage is 0.025% cap­saicin cream applied four times a day. The most com­mon side effect is a sting­ing or burn­ing sen­sa­tion in the area.

If pos­si­ble, wear dis­pos­able gloves (avail­able at drug­stores) before apply­ing the cream. Be care­ful not to touch the eye area or open skin. A tube or jar of cap­saicin cream typ­i­cally costs between $8 and $25.

3) Vit­a­min D
Chronic mus­cle pain can be a symp­tom of vit­a­min D defi­ciency. Vit­a­min D is found in fish with small bones, for­ti­fied milk and cereal, and expo­sure to sunlight.

Risk fac­tors for vit­a­min D defi­ciency are:

•darker pig­mented skin (e.g. His­panic, African Amer­i­can, Asian) does not con­vert UV rays effi­ciently to vit­a­min D

•diges­tive dis­or­ders, such as celiac disease

•use of glu­co­cor­ti­coid med­ica­tions for con­di­tions such as lung dis­eases and allergies

•min­i­mal sun expo­sure (elderly, insti­tu­tion­al­ized, home­bound, veiled or heavily-clothed individuals)

•lat­i­tude and sea­son — for exam­ple, peo­ple in Boston do not pro­duce vit­a­min D from sun expo­sure between Novem­ber and February

A study by the Uni­ver­sity of Min­nesota looked at the preva­lence of vit­a­min D defi­ciency in 150 peo­ple with chronic mus­cu­loskele­tal pain. Researchers found that 93% of patients had vit­a­min D defi­ciency. All peo­ple with darker pig­mented skin (African Amer­i­can, East African, His­panic, and Native Amer­i­can ori­gin) had vit­a­min D deficiency.

Another inter­est­ing find­ing was that the major­ity of peo­ple with severe vit­a­min D defi­ciency were under 30 years of age. Sea­son was not a sig­nif­i­cant factor.

The researchers con­cluded that all peo­ple with per­sis­tent, non-specific mus­cu­loskele­tal pain should be screened for vit­a­min D deficiency.

4) Music Ther­apy
Music ther­apy is a low-cost nat­ural ther­apy that has been found to reduce the dis­abil­ity, anx­i­ety, and depres­sion asso­ci­ated with chronic pain.

A study eval­u­ated the influ­ence of music ther­apy in hos­pi­tal­ized patients with chronic back pain. Researchers ran­dom­ized 65 patients to receive, on alter­nate months, phys­i­cal ther­apy plus 4 music ther­apy ses­sions or phys­i­cal ther­apy alone.

Music ther­apy sig­nif­i­cantly reduced dis­abil­ity, anx­i­ety, and depres­sion. Music had an imme­di­ate effect on reduc­ing pain, although the results were not sta­tis­ti­cally significant.

5) Vit­a­min B12
Vit­a­min B12 has been found to relieve low back pain. A double-blind Ital­ian study exam­ined the safety and effec­tive­ness of vit­a­min B12 for low back pain. Peo­ple who received vit­a­min B12 showed a sta­tis­ti­cally sig­nif­i­cant reduc­tion in pain and dis­abil­ity. They also used less pain med­ica­tion than the placebo group.

Besides pain, other symp­toms of vit­a­min B12 defi­ciency are numb­ness and tin­gling, irri­tabil­ity, mild mem­ory impair­ment, and depression.

Risk fac­tors for vit­a­min B12 defi­ciency are :

•per­ni­cious anemia

•med­ica­tions (stom­ach acid-blocking medications)

•inad­e­quate intake of meat or dairy products

•infec­tion (small intes­tine bac­te­r­ial over­growth, parasites)

•Diges­tive dis­eases (stom­ach removal surgery, celiac dis­ease, Crohn’s disease

Vit­a­min B12 mus­cle injec­tions are the stan­dard treat­ment for vit­a­min B12 defi­ciency. Stud­ies have found vit­a­min B12 sub­lin­gual tablets (placed under the tongue for absorp­tion) and nasal gel are also effective.

6) Mag­ne­sium
Mag­ne­sium is the fourth most abun­dant min­eral in the body. It’s involved in over 300 bio­chem­i­cal reac­tions in the body.

Mag­ne­sium helps main­tain nor­mal mus­cle and nerve func­tion, keeps heart rhythm steady, sup­ports a healthy immune sys­tem, and keeps bones strong. Mag­ne­sium also helps reg­u­late blood sugar lev­els, pro­motes nor­mal blood pres­sure, and is known to be involved in energy metab­o­lism and pro­tein synthesis.

Symp­toms of mag­ne­sium defi­ciency include mus­cle spasms and pain, pre­men­strual syn­drome, irri­tabil­ity, depres­sion, insulin resis­tance, high blood pres­sure, irreg­u­lar heart rhythms, and heart disease.

A Ger­man study found that min­eral sup­ple­ments increased intra­cel­lu­lar mag­ne­sium lev­els by 11% and was asso­ci­ated with a reduc­tion in pain symp­toms in 76 out of 82 peo­ple with chronic low back pain.

7) Wil­low Bark
The bark of the white wil­low tree (Salix alba) has pain-relieving prop­er­ties sim­i­lar to aspirin. An ingre­di­ent in white wil­low bark, called salicin, is con­verted in the body to sal­i­cylic acid (aspirin is also con­verted to sal­i­cylic acid once in the body). Sal­i­cylic acid is believed to be the active com­pound that relieves pain and inflammtion.

A num­ber of stud­ies have com­pared white wil­low to med­ica­tion or placebo:

•A Uni­ver­sity of Syd­ney study com­pared the effects of wil­low bark extract to refe­coxib, a Cox-2 inhibitor pain med­ica­tion. In the study, 114 patients received a herbal extract con­tain­ing 240 mg of salicin and 114 received 12.5 mg of refe­coxib every day. After four weeks, both groups had a com­pa­ra­ble reduc­tion in pain.

•A study in the Amer­i­can Jour­nal of Med­i­cine exam­ined 191 patients with an exac­er­ba­tion of chronic low back pain. They were ran­domly assigned to receive a wil­low bark extract with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo. In the fourth week of treat­ment, 39% of peo­ple receiv­ing the high-dose extract were pain-free, 21% receiv­ing the low-dose were pain-free, and 6% of peo­ple receiv­ing the placebo were pain-free. Peo­ple in the high-dose group improved after the first week. Sig­nif­i­cantly more peo­ple in the placebo group required pain medication.

Yoga for Back Pain
Yoga cre­ates bal­ance in the body through var­i­ous poses that develop flex­i­bil­ity and strength. A study of peo­ple with chronic mild low back pain com­pared Iyen­gar yoga to back edu­ca­tion. After 16 weeks, there was a sig­nif­i­cant reduc­tion in pain inten­sity, dis­abil­ity, and reliance on pain med­ica­tion in the yoga group. Ben­e­fits were also seen at three month fol­low up assessments.

Another study com­pared yoga, con­ven­tional exer­cise, and a self care book for peo­ple with chronic low back pain. Back func­tion in the yoga group was supe­rior to the book and exer­cise groups at 12 weeks. Although there was no dif­fer­ence in symp­toms at 12 weeks, at 26 weeks, the yoga group was supe­rior to the book group.

9) Bowen Ther­apy
Bowen ther­apy is a type of gen­tle body­work that was devel­oped in Aus­tralia by osteopath Tom Bowen (1916–1982). Bowen ther­apy is more widely used in Aus­tralia and Europe, but it has been grow­ing in pop­u­lar­ity in North America.

Bowen ther­a­pists use a series of spe­cial­ized “moves” using their fin­gers and thumbs. The moves typ­i­cally involve the ther­a­pist pulling the skin slack away from the mus­cle, apply­ing pres­sure, and then quickly releas­ing the tension.

These moves are per­formed on pre­cise areas of mus­cles where spe­cial recep­tors are located. Nerve impulses are sent to the brain, result­ing in mus­cle relax­ation and reduc­tion of pain.

The moves are not con­tin­u­ous — the ther­a­pist allows the client to rest for a few min­utes between each move. A typ­i­cal treat­ment is between 30 to 40 minutes.

10) Breath­ing Tech­niques
Breath­ing tech­niques that make use of the mind-body con­nec­tion have been found to reduce pain. These tech­niques inte­grate body aware­ness, breath­ing, move­ment, and med­i­ta­tion. What’s great about breath­ing tech­niques is that you can do them your­self at home at no cost.

One study com­pared 6–8 weeks (12 ses­sions) of breath ther­apy to phys­i­cal ther­apy. Patients improved sig­nif­i­cantly with breath ther­apy. Changes in stan­dard low back pain mea­sures of pain and dis­abil­ity were com­pa­ra­ble to those result­ing from high qual­ity, extended phys­i­cal ther­apy. Breath ther­apy was found to be safe. Other ben­e­fits of breath ther­apy were improved cop­ing skills and new insight into the effect of stress on the body.

11) Mas­sage Ther­apy
When many peo­ple have back aches and pain, the first thing they think of is mas­sage. Stud­ies have found that mas­sage may be effec­tive for sub­a­cute and chronic pain. It has also been found to reduce anx­i­ety and depres­sion asso­ci­ated with chronic pain. Mas­sage ther­apy is the most pop­u­lar ther­apy for low back pain dur­ing pregnancy.

12) Chi­ro­prac­tic
Back pain is one of most com­mon rea­sons peo­ple see a chi­ro­prac­tor. Doc­tors of chi­ro­prac­tic use chi­ro­prac­tic spinal manip­u­la­tion to restore joint mobil­ity. They man­u­ally apply a con­trolled force to joints that have become restricted by mus­cle injury, strain, inflam­ma­tion, and pain. Manip­u­la­tion is believed to relieve pain and mus­cle tight­ness and encour­age healing.

A study pub­lished in the Spine Jour­nal exam­ined manip­u­la­tions com­pared to sim­u­lated manip­u­la­tions in 102 peo­ple with back pain and/or radi­at­ing pain. The researchers found that active manip­u­la­tions were more effec­tive at reduc­ing acute back pain and sci­at­ica with disc protrusion.

13) Alexan­der Tech­nique
Alexan­der tech­nique teaches peo­ple to improve their pos­ture and elim­i­nate bad habits such as slouch­ing, which can lead to pain, mus­cle ten­sion, and decreased mobil­ity. This tech­nique was cre­ated by Fred­er­ick Matthias Alexan­der (1869–1955), an Aus­tralian actor who learned how to cor­rect hoarse­ness in his voice by improv­ing his posture.

You can learn Alexan­der tech­nique in pri­vate ses­sions or group classes. A typ­i­cal ses­sion lasts about 45 min­utes. Dur­ing that time, the instruc­tor notes the way you carry your­self and coaches you with ver­bal instruc­tion and gen­tle touch.

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(Con­tin­ued from Page 2)
10) Breath­ing Tech­niques
Breath­ing tech­niques that make use of the mind-body con­nec­tion have been found to reduce pain. These tech­niques inte­grate body aware­ness, breath­ing, move­ment, and med­i­ta­tion. What’s great about breath­ing tech­niques is that you can do them your­self at home at no cost.

One study com­pared 6–8 weeks (12 ses­sions) of breath ther­apy to phys­i­cal ther­apy. Patients improved sig­nif­i­cantly with breath ther­apy. Changes in stan­dard low back pain mea­sures of pain and dis­abil­ity were com­pa­ra­ble to those result­ing from high qual­ity, extended phys­i­cal ther­apy. Breath ther­apy was found to be safe. Other ben­e­fits of breath ther­apy were improved cop­ing skills and new insight into the effect of stress on the body.
•Breath­ing tech­nique — How to breathe with your belly
11) Mas­sage Ther­apy
When many peo­ple have back aches and pain, the first thing they think of is mas­sage. Stud­ies have found that mas­sage may be effec­tive for sub­a­cute and chronic pain. It has also been found to reduce anx­i­ety and depres­sion asso­ci­ated with chronic pain. Mas­sage ther­apy is the most pop­u­lar ther­apy for low back pain dur­ing preg­nancy.
•Find a mas­sage ther­a­pist
12) Chi­ro­prac­tic
Back pain is one of most com­mon rea­sons peo­ple see a chi­ro­prac­tor. Doc­tors of chi­ro­prac­tic use chi­ro­prac­tic spinal manip­u­la­tion to restore joint mobil­ity. They man­u­ally apply a con­trolled force to joints that have become restricted by mus­cle injury, strain, inflam­ma­tion, and pain. Manip­u­la­tion is believed to relieve pain and mus­cle tight­ness and encour­age healing.

A study pub­lished in the Spine Jour­nal exam­ined manip­u­la­tions com­pared to sim­u­lated manip­u­la­tions in 102 peo­ple with back pain and/or radi­at­ing pain. The researchers found that active manip­u­la­tions were more effec­tive at reduc­ing acute back pain and sci­at­ica with disc pro­tru­sion.
•Find a doc­tor of chi­ro­prac­tic
13) Alexan­der Tech­nique
Alexan­der tech­nique teaches peo­ple to improve their pos­ture and elim­i­nate bad habits such as slouch­ing, which can lead to pain, mus­cle ten­sion, and decreased mobil­ity. This tech­nique was cre­ated by Fred­er­ick Matthias Alexan­der (1869–1955), an Aus­tralian actor who learned how to cor­rect hoarse­ness in his voice by improv­ing his posture.

You can learn Alexan­der tech­nique in pri­vate ses­sions or group classes. A typ­i­cal ses­sion lasts about 45 min­utes. Dur­ing that time, the instruc­tor notes the way you carry your­self and coaches you with ver­bal instruc­tion and gen­tle touch.
•More about Alexan­der tech­nique
14) Pro­lother­apy
Pro­lother­apy addresses dam­aged lig­a­ments (bands of con­nec­tive tis­sue that help keep bones attached to each other) to relieve chronic mus­cu­loskele­tal pain.

How does it work? Ten­dons and lig­a­ments in the back often do not heal com­pletely after injury. Bones of the spine become less sta­ble, which can lead to chronic pain.

Pro­lother­apy involves the injec­tion of a liq­uid solu­tion into soft tis­sues such as lig­a­ments and ten­dons. This trig­gers local inflam­ma­tion and trig­gers the body’s nat­ural heal­ing response which repairs the weak­ened soft tis­sues and relieves pain. Unlike drugs, pro­lother­apy is thought to address the under­ly­ing problem.

After locat­ing the areas that require treat­ment, the doc­tor inserts a thin nee­dle with the solu­tion into the area. There is often mild pain, but it can be reduced by using a local anaes­thetic. A typ­i­cal course of treat­ment is 10 to 25 ses­sions for back pain. Since it is believed to repair the joint, no other treat­ment is necessary.

Pre­lim­i­nary stud­ies have found that back pain, which often involves lig­a­ment injury, responds par­tic­u­larly well to pro­lother­apy. It is the posi­tion of the Amer­i­can Asso­ci­a­tion of Orthopaedic Med­i­cine that pro­lother­apy is a safe and effec­tive ther­apy for the treat­ment of selected cases of low back pain and other chronic myofas­cial pain syn­dromes. Pro­lother­apy injec­tions must be admin­is­tered by a med­ical doc­tor (M.D.), osteopath (D.O.) or by a state-licensed natur­o­pathic doc­tor (N.D.) in cer­tain states.

15) Bal­neother­apy
Bal­neother­apy is one of the old­est ther­a­pies for pain relief. The term “bal­neo” comes from the Latin word, bal­neum, mean­ing bath. Bal­neother­apy is a form of hydrother­apy that involves bathing in min­eral water or warm water.
•A study com­pared bathing in min­eral water to plain tap water in 60 peo­ple with low back pain. They found that min­eral water con­tain­ing sul­phur was supe­rior in reduc­ing pain and improv­ing mobil­ity com­pared with tap water.

•A sys­tem­atic review and meta-analysis pub­lished in the jour­nal Rheuma­tol­ogy assessed spa ther­apy and bal­neother­apy for low back pain. The researchers found that the data sug­gest ben­e­fi­cial effects com­pared to con­trol groups. They con­cluded that the results were encour­ag­ing and that large-scale tri­als were war­ranted.
Dead Sea salts and other sulphur-containing bath salts can be found in spas, health food stores, and online.

Peo­ple with heart con­di­tions should not use bal­neother­apy unless under the super­vi­sion of their pri­mary care provider.