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Low-Back Pain and CAM

Four out of five American adults will experience low-back pain at some time in their lives. It is a major public health burden in the United States and is the leading cause of work-related disability and missed days of work, and the fifth most common reason for physician visits. A 2006 report estimated that annual costs of low-back pain in this country exceed $100 billion. Two-thirds of that is for indirect costs, such as lost wages and reduced productivity.

Low-back pain is often classified either as acute (pain that lasts up to 4 weeks); sub-acute (pain lasting from 4 to 12 weeks); or chronic (pain lasting for 3 months or longer). Only a small percentage of acute cases of low-back pain‚ 2 to 7 percent, according to one guideline‚ become chronic. However, this condition can cause substantial disability and accounts for the majority of low-back pain associated costs.

Nonspecific low-back pain is pain occurring primarily in the back with no signs of a serious underlying condition, spinal stenosis or radiculopathy, or another specific spinal cause. Degenerative changes on lumbar imaging correlate poorly with symptoms and are usually considered nonspecific.

"Low-back pain is one of our society's most common, burdensome health problems," says Josephine P. Briggs, M.D., Director of NCCAM. "The currently available treatments have limitations. Many patients turn to complementary and alternative medicine (CAM) with the hope of decreasing pain, improving function and quality-of-life, preventing recurrence and chronicity, or avoiding side effects of other treatments."

According to the 2007 National Health Interview Survey, back pain is the most common condition for which American adults use CAM. Data suggest that the CAM therapies most frequently used for low-back pain are chiropractic/manipulation, massage, and acupuncture. Other CAM approaches include yoga, herbal and other dietary supplements, devices, and lifestyle products.

Identifying optimal treatment approaches for low-back pain can be difficult for both patients and clinicians. A thorough patient assessment is the first step for a clinician who may be considering recommending CAM therapies. Clinical practice guidelines stress the importance of ruling out serious underlying conditions and evaluating a patient's psychosocial factors and emotional distress when doing an assessment of low-back pain.

"There is much more to learn about the effectiveness and safety of CAM therapies for chronic low-back pain and other chronic pain conditions," says Dr. Briggs. "Building a better and clearer evidence base in these areas, and sharing reliable information, are priorities for NCCAM."