What is pain?

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen, chest, pelvis, or you may feel pain all over.

There are two types of pain:

• Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
• Chronic pain lasts for a long time, and can cause severe problems

What are pain relievers?

Pain relievers are medicines that reduce or relieve pain. There are many different pain medicines, and each one has advantages and risks. Some are over-the-counter (OTC) medicines. Others are stronger medicines, which are available by prescription. The most powerful prescription pain relievers are opioids. They are very effective, but people who take them are at risk of addiction and overdose.

Because of the side effects and risks of pain relievers, you may want to try non-drug treatments first. And if you do need to take medicines, also doing some non-drug treatments may allow you to take a lower dose.

What are some non-drug treatments for pain?

There are many non-drug treatments that can help with pain. It is important to check with your health care provider before trying any of them:

• Acupuncture involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
• Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.
• Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include
  • Transcutaneous electrical stimulation (TENS)
  • Implanted electric nerve stimulation
  • Deep brain or spinal cord stimulation
• Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax, and relieve stress and pain.
• Meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings.
• Physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.
• Psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by
  • Teaching them coping skills, to be able to better deal with the stress that pain can cause
  • Addressing negative thoughts and emotions that can make pain worse
  • Providing them with support
• Relaxation therapy can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.
• Surgery can sometimes be necessary to treat severe pain, especially when it is caused by back problems or serious musculoskeletal injuries. There are always risks to getting surgery, and it does not always work to treat pain. So it is important to go through all of the risks and benefits with your health care provider.

Looking to add a complementary health treatment—like yoga or meditation—to your pain management approach?

Before you dive in, make sure to check with your health care provider. Complementary health approaches are generally safe, but you have to make sure the approach you choose is safe for you and performed correctly. For treatments such as acupuncture or massage, be sure you are treated by a professional.

To help you get started, here are overviews of five types of complementary health treatments, with helpful information in part from the National Center for Complementary and Integrative Health's (NCCIH) "Pain: Considering Complementary Approaches" e-book.

Acupuncture. Acupuncture uses needles to stimulate specific areas of the body to reduce pain. As part of the National Institutes of Health's Helping to End Addiction Long-term Initiative, NCCIH-supported researchers study how acupuncture can help older adults with chronic low back pain. Other research has found that acupuncture can help with fibromyalgia pain, knee pain, and headaches.

Spinal manipulation. Spinal manipulation is one of the most commonly used complementary health treatments in the U.S. It involves a chiropractor or other health professional applying a controlled force to the joints of the spine using their hands or a device. Spinal manipulation may be a helpful nondrug treatment for people with chronic low back pain. It may also help relieve headaches, including migraines.

Meditation and mindfulness. Meditation can involve focusing your mind on a particular sensation (such as breathing), a sound, a repeated word or phrase, or an image. Mindfulness helps you focus your attention or awareness on the present moment. Recent research supported by NCCIH has shown that using mindfulness to help patients with chronic pain and dependence on opioids has promise.

Yoga. Yoga is a series of poses, movements, and deep-breathing exercises. It often combines deep breathing and meditation. Studies show that yoga can be helpful for low back pain, with effects similar to those of exercise. Research on yoga for neck pain and arthritis has been limited, but some studies have had promising results, according to NCCIH.

Dietary supplements and natural products. According to NCCIH, natural products used in complementary health include herbs, vitamins, minerals, and probiotics. These products are often marketed as dietary supplements. The U.S. Food and Drug Administration regulates dietary supplements, but the regulations are different from those for prescription medicines. Early results of studies using probiotics to ease irritable bowel syndrome pain have been promising. And omega-3 fatty acids, like those found in fish oil, may help rheumatoid arthritis symptoms.

What’s the Bottom Line?

How much do we know about the effectiveness of complementary health approaches for chronic pain?

• A growing body of evidence suggests that some complementary approaches, such as acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong, and yoga, may help to manage some painful conditions.

What do we know about the safety of complementary health approaches for chronic pain?

• Although the psychological and/or physical approaches (e.g., acupuncture, meditation, yoga, massage) studied for chronic pain have good safety records, that doesn’t mean that they’re risk-free for everyone. Your health and special circumstances (such as pregnancy) may affect the safety of these approaches. If you’re considering nutritional approaches such as dietary supplements, remember that natural doesn’t always mean safe and that some dietary supplements may have side effects or interact with medications.

What Is Chronic Pain and Why Is It Important?

Chronic pain is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2019 National Health Interview Survey (NHIS) show that:

• About 20.4 percent of U.S adults had chronic pain (defined as pain on most days or every day in the past 3 months).
• About 7.4 percent of U.S. adults had high-impact chronic pain (defined as chronic pain that limited their life or work activities on most days or every day for the past 3 months).

Chronic pain becomes more common as people grow older, at least in part because some health problems that can cause pain, such as osteoarthritis, become more common with advancing age. Military veterans are another group at increased risk for chronic pain; U.S. national survey data show that both pain in general and severe pain are more common among veterans than nonveterans. Chronic pain is more common in rural areas than urban areas in the United States.

Analysis of data from the 2010–2017 NHIS Sample Adult Core and Adult Functioning and Disability Supplement show that prevalence of chronic pain varies by race and Hispanic origin, with a recent publication suggesting the highest percentage among non-Hispanic American Indian/Alaska Native respondents and the lowest among non-Hispanic Asians. 

Not all people with chronic pain have a health problem diagnosed by a health care provider, but among those who do, the most frequent conditions are low-back pain or osteoarthritis, according to a national survey. Other common diagnoses include rheumatoid arthritis, migraine, carpal tunnel syndrome, and fibromyalgia.

Chronic pain may result from an underlying disease or health condition, an injury, medical treatment (such as surgery), inflammation, or a problem in the nervous system (in which case it is called “neuropathic pain”); or the cause may be unknown. Pain can affect quality of life and productivity, and it may be accompanied by difficulty in moving around, disturbed sleep, anxiety, depression, and other problems.¹

¹Certain chronic conditions, several of which cause pain, may occur together; some individuals have two or more of these problems. These conditions include chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, temporomandibular joint dysfunction, and vulvodynia (chronic vulvar pain). It is not known whether these disorders share a common cause.

What the Science Says About Complementary Health Approaches for Chronic Pain

The scientific evidence suggests that some complementary health approaches may help people manage chronic pain. 

A comprehensive description of scientific research on all the complementary approaches that have been studied for chronic pain is beyond the scope of this fact sheet. This section highlights the research status of some approaches used for common kinds of pain.

Chronic Pain in General

Some recent research has looked at the effects of complementary approaches on chronic pain in general rather than on specific painful conditions. 

• A 2017 review looked at complementary approaches with the opioid crisis in mind, to see which ones might be helpful for relieving chronic pain and reducing the need for opioid therapy to manage pain. There was evidence that acupuncture, yoga, relaxation techniques, tai chi, massage, and osteopathic or spinal manipulation may have some benefit for chronic pain, but only for acupuncture was there evidence that the technique could reduce a patient’s need for opioids.
• Products containing substances from cannabis (marijuana), which typically include both tetrahydrocannabinol (THC) and cannabidiol (CBD), have been tested for their effects on chronic pain in short-term studies. Oral products with high THC/CBD ratios and sublingual (under-the-tongue) products with roughly equal amounts of THC and CBD may reduce chronic pain in the short term but may also have side effects including dizziness and sleepiness. Not much is known about other cannabinoid formulations or the effects of long-term use.
• Hypnosis may reduce chronic pain if patients participate in enough sessions (at least eight), according to a few studies.
• Studies on chronic pain showed that mindfulness-based interventions and cognitive behavioral therapy are both helpful in decreasing pain intensity and improving physical functioning, with no important difference between the two approaches. Cognitive behavioral therapy is the prevailing psychological intervention for chronic pain.
• Studies have shown that music-based interventions can reduce self-reported pain and depression symptoms in people with chronic pain. Effects were greater when the patient, rather than the researcher, chose the music.

Back and Neck Pain

• A large review of individual data from multiple studies showed that acupuncture was more effective than either no treatment or sham (fake) acupuncture for back or neck pain. The difference between acupuncture and no treatment was greater than the difference between acupuncture and sham acupuncture. A 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for management of both acute and chronic low-back pain.
• Evaluations of massage therapy for low-back pain have found weak evidence that it may be helpful. The ACP guideline recommends massage as an option for acute low-back pain, based on low-quality evidence, but does not recommend massage for chronic low-back pain. Massage therapy may be helpful for neck pain, but the benefits may only last for a short time.
• Studies show that mindfulness-based stress reduction is associated with a small improvement in chronic low-back pain. The ACP guideline recommends mindfulness-based stress reduction as an option for chronic low-back pain, based on moderate-quality evidence.
• Progressive muscle relaxation is one of several nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline. There is evidence that this technique can lead to moderate improvements in low-back pain and back function.
• Biofeedback may moderately improve low-back pain. It is one of the nondrug approaches suggested as the first step in treating chronic low-back pain in the ACP treatment guideline.
• The 2017 ACP guideline includes spinal manipulation as an option for treating both acute and chronic low-back pain. There is low-to-moderate quality evidence that spinal manipulation can reduce pain and improve function in people with chronic nonspecific neck pain.
• Tai chi, either alone or in addition to physical therapy, may decrease the intensity of pain and improve everyday function in people with low-back pain. The ACP guideline includes tai chi as an option for treatment of chronic low-back pain.
• Studies of yoga for low-back pain have shown yoga to be helpful in both the short term (1 to just under 6 months) and intermediate term (6 to just under 12 months). The effects of yoga are similar to those of other types of exercise. The 2017 ACP guideline included yoga as an option for initial treatment of chronic but not acute low-back pain. Practicing yoga has been shown to reduce both the intensity of neck pain and disability related to neck pain.
• Several types of herbal preparations have been evaluated for low-back pain. There is evidence that topical products containing the herb cayenne, such as creams and plasters, can reduce pain. Topical products that contain two other herbs, comfrey and lavender essential oil, and two herbs used orally, white willow bark and devil’s claw, may also be helpful, but the evidence for these herbs is not as strong as that for cayenne.

Osteoarthritis

• Acupuncture may be helpful for knee pain associated with osteoarthritis. There’s less evidence on whether it’s helpful for osteoarthritis of the hip. The 2019 clinical practice guideline from the American College of Rheumatology and the Arthritis Foundation conditionally (i.e., weakly) recommends the use of acupuncture for arthritis of the hand, hip, or knee but acknowledges that the evidence on acupuncture is controversial and that most of the studies that have shown beneficial effects have been for knee osteoarthritis.
• Low-to-moderate quality evidence suggests that massage may help reduce pain associated with arthritis; most of the research has been on osteoarthritis rather than rheumatoid arthritis. However, the guideline from the American College of Rheumatology and the Arthritis Foundation conditionally (i.e., weakly) recommends against the use of massage therapy for the management of osteoarthritis of the hip or knee because of weaknesses in the scientific evidence.
• In research studies, people with osteoarthritis who practiced tai chi experienced improvements in pain, stiffness, balance, and physical function. The guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends tai chi for the management of osteoarthritis of the knee or hip.
• A limited amount of research suggests that yoga may be helpful for improving pain, function, and stiffness in people with osteoarthritis of the knee. The guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends yoga for patients with knee osteoarthritis based on similarities to tai chi, which has been studied more extensively.
• In their guideline for the management of osteoarthritis of the hand, hip, and knee, the American College of Rheumatology and the Arthritis Foundation strongly recommend against the use of glucosaminefor people with arthritis in any of these three body sites. The rationale is that studies with the lowest risk of bias have not shown glucosamine to work better than a placebo (an inactive substance). The guideline also recommends against the use of chondroitin or combination glucosamine/chondroitin products for osteoarthritis of the hip or knee. It conditionally recommends for the use of chondroitin for hand osteoarthritis, however, based on a single study that showed a pain-relieving effect, as well as chondroitin’s apparent safety.
• The guideline from the American College of Rheumatology and the Arthritis Foundation conditionally recommends against the use of fish oil for osteoarthritis because only one study exists, and that study did not show efficacy of a higher dose of fish oil over a lower dose. The guideline conditionally recommends against the use of vitamin D for osteoarthritis because the overall evidence does not show a benefit.
• There isn’t enough research on dimethyl sulfoxide (DMSO) or methylsulfonylmethane (MSM) for osteoarthritis pain to allow conclusions to be reached. The evidence on S-adenosyl-L-methionine(SAMe) for osteoarthritis of the knee or hip is inconclusive.

Rheumatoid Arthritis

• The term balneotherapy refers to bathing in mineral water for health purposes and related techniques such as mud packs. There’s evidence that balneotherapy may be helpful for improving quality of life in people with rheumatoid arthritis.
• Omega-3 fatty acids of the types found in fish oil may have beneficial effects on rheumatoid arthritis when used in addition to conventional drug therapy.
• No nutritional approach other than omega-3 fatty acids has shown clear benefits for rheumatoid arthritis, but there is preliminary evidence for a few dietary supplements, particularly gamma-linolenic acid (contained in evening primrose oil, borage seed oil, and black current seed oil) and the herb thunder god vine.
• A few small studies have evaluated tai chi in people with rheumatoid arthritis, but it’s uncertain whether this approach is helpful.

Headaches

• There’s moderate-quality evidence that acupuncture may reduce the frequency of migraines and moderate-to-low quality evidence that it may reduce the frequency of tension headaches. Studies that compared acupuncture with various drugs for preventing migraine found that acupuncture was slightly more effective and that study participants who received acupuncture were much less likely than those who received drugs to drop out of studies because of side effects.
• Studies of electromyography (EMG) biofeedback, a type of biofeedback involving measurements of muscle tension, have found this technique helpful for tension headaches.
• Some studies of relaxation techniques for migraines or tension headaches have shown improvements, including a reduction in headache frequency, in people who used the techniques. The evidence is strongest for relaxation techniques used in combination with cognitive behavioral therapy.
• Spinal manipulation may reduce the frequency and intensity of cervicogenic headaches (head pain that originates from a problem in the neck). Preliminary evidence suggests it may also be helpful for migraines.
• A small amount of research suggests that practicing yoga may reduce headache frequency, headache duration, and pain intensity, with beneficial effects seen primarily in tension headaches rather than migraines.
• Several dietary supplements have been studied for migraines. There is some evidence that coenzyme Q10, feverfew, magnesium, and the B vitamin riboflavin might help reduce the frequency of migraines. For all these supplements, the amount of evidence is small. The herb butterbur appears to reduce the frequency of migraines. However, serious concerns have been raised about possible liver toxicity from butterbur.
• The results of a recent study showed that diets high in omega-3 fatty acids may be helpful for migraines. Omega-3 supplements have not been shown to make migraines less frequent or severe, but a small amount of evidence suggests that they might reduce the duration of migraine attacks.

Fibromyalgia

• Low-to-moderate quality evidence suggests that acupuncture is helpful for pain associated with fibromyalgia.
• Several studies show that massage therapy, if continued for 5 weeks or longer, may reduce pain and improve other symptoms in people with fibromyalgia.
• A small amount of research suggests that tai chi can help reduce pain and improve other symptoms in people with fibromyalgia.
• The term balneotherapy refers to bathing in mineral water for health purposes and related techniques such as mud packs. There’s evidence that balneotherapy may be helpful for some symptoms of fibromyalgia.
• The effectiveness of biofeedback, mindfulness, movement therapies, and relaxation-based therapies for fibromyalgia is unclear because the quality of the evidence on these approaches is low.
• Supplementation with vitamin D may reduce fibromyalgia pain, particularly in individuals with vitamin D deficiency.
• There is insufficient evidence that other dietary supplements can relieve fibromyalgia pain. 

Irritable Bowel Syndrome

• The evidence suggests that acupuncture is no more effective than sham acupuncture for irritable bowel syndrome (IBS) symptoms, but it may be helpful when used in addition to other forms of treatment.
• The 2021 American College of Gastroenterology (ACG) guideline for treatment of IBS suggests that gut-directed hypnotherapy or other gut-directed psychotherapies can be used to treat global IBS symptoms in some patients, but the quality of the evidence is very low.
• Probiotics may be helpful for symptoms of IBS, but different strains of probiotics may have different effects. The 2021 ACG guideline suggests that probiotics should not be used for the treatment of IBS symptoms because the current evidence doesn’t clearly show which probiotics might be helpful.
• Studies on peppermint have suggested that it may be helpful for overall symptoms and abdominal pain in people with IBS, and the ACG guideline suggests that it can be used, although the evidence is not strong.

Less-Studied Complementary Approaches

• Research on the plant product kratom is in its early stages, and much more needs to be learned about its effects in the body, its safety, and whether it may have therapeutic uses, including possible use in the treatment of pain.
• Reiki is a complementary health approach in which practitioners place their hands lightly on or just above the person, with the goal of facilitating the person’s own healing response. There isn’t enough high-quality research to evaluate whether Reiki is helpful for relieving pain.
• Magnets. Both static magnets and electromagnets have been studied as treatments for pain. Static magnets have magnetic fields that don’t change. They may be put into products such as wristbands, shoe insoles, bracelets, and bed pads. There’s not much research on static magnets for pain, and there’s no conclusive evidence that they’re helpful for any type of pain. Electromagnets become magnetic when an electrical current charges the metal. Current research suggests that electromagnetic field therapy can relieve pain and improve function in patients with various musculoskeletal pain conditions and some osteoarthritis conditions, although the data are mixed.

What the Science Says About Safety and Side Effects

As with any treatment, it’s important to consider safety before using complementary health approaches. Safety depends on the specific approach and on the health of the person using it. If you’re considering or using a complementary approach for pain, check with your health care providers to make sure it’s safe for you.

Safety of Psychological and Physical Approaches

• Psychological and physical complementary health approaches, such as acupuncture, hypnosis, massage therapy, mindfulness/meditation, music-based interventions, relaxation techniques, spinal manipulation, tai chi, qigong, and yoga, are generally safe for healthy people if they’re performed appropriately.
  • People with medical conditions and people who are pregnant may need to modify or avoid some of these practices.
  • Like other forms of exercise, complementary health practices that involve movement, such as tai chi and yoga, can cause sore muscles and may involve some risk of injury.
  • It’s important for practitioners and teachers of mind and body practices to be properly qualified and to follow appropriate safety precautions.

Safety of Nutritional Approaches

• “Natural” doesn’t always mean “safe.” Some dietary supplements may have side effects and may interact with medications. 
• The U.S. Food and Drug Administration has warned the public about several dietary supplements promoted for arthritis or pain that were tainted with prescription drugs.

Guidelines for the Treatment of Chronic Pain Conditions

National health professional organizations have issued guidelines for treating several chronic pain conditions that address the use of complementary health approaches.

• A clinical practice guideline from the American College of Physicians encourages the use of nonpharmacologic approaches as initial treatment for chronic low-back pain. The options they suggest include several complementary approaches—acupuncture, mindfulness-based stress reduction, tai chi, yoga, progressive relaxation, biofeedback, and spinal manipulation—as well as conventional methods such as exercise and cognitive behavioral therapy.
• The American College of Rheumatology and the Arthritis Foundation have published a guideline for the management of osteoarthritis of the hand, hip, or knee that includes recommendations for or against the use of a variety of complementary health approaches. For example, the guideline strongly recommends for the use of tai chi for osteoarthritis of the hip or knee and strongly recommends against the use of glucosamine for osteoarthritis at any of the three body sites. The guideline’s recommendations are discussed in more detail in the Osteoarthritis section of this fact sheet.
• The American College of Gastroenterology clinical guideline for irritable bowel syndrome includes conditional (weak) recommendations in favor of peppermint and gut-directed psychotherapies (a group of therapies that includes gut-directed hypnotherapy). The guideline includes a conditional recommendation against the use of probiotics. 
• The 2022 Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain concludes: “Evidence exists that multiple noninvasive nonpharmacologic interventions improve chronic pain and function, with small to moderate effects in specific pain conditions, and are not associated with serious harms.” Several of the nonpharmacologic approaches discussed in this fact sheet, such as acupuncture, massage therapy, mindfulness-based interventions, tai chi, and yoga, are mentioned in the CDC practice guideline as being appropriate for some types of chronic pain. The guideline recommends maximizing pain treatment with nonpharmacologic and nonopioid pharmacologic treatments as appropriate. 

If You're Considering Complementary Health Approaches for Chronic Pain

• Don’t use an unproven product or practice to postpone seeing a health care provider about chronic pain or any other health problem.
• Learn about the product or practice you are considering, especially the scientific evidence on its safety and whether it works.
• Talk with the health care providers you see for chronic pain. Tell them about the product or practice you’re considering and ask any questions you may have. They may be able to advise you on its safety, use, and likely effectiveness.
• If you’re considering a practitioner-provided complementary health approach such as spinal manipulation, massage, or acupuncture, ask a trusted source (such as your health care provider or a nearby hospital) to recommend a practitioner. Find out about the training and experience of any practitioner you’re considering. Ask whether the practitioner has experience working with your pain condition.
• If you’re considering dietary supplements, keep in mind that they can cause health problems if not used correctly, and some may interact with prescription or nonprescription medications or other dietary supplements. Your health care provider can advise you. If you’re pregnant or nursing a child, or if you’re considering giving a child a dietary supplement, it’s especially important to consult your (or the child’s) health care provider.

Chiropractic

Chiropractic is a licensed health care profession that emphasizes the body’s ability to heal itself. Treatment typically involves manual therapy, often including spinal manipulation. Other forms of treatment, such as exercise and nutritional counseling, may be used as well.

What Chiropractors Do

Chiropractors approach patient care in a manner similar to that used in conventional medicine. They interview the patient, obtain a detailed health history, perform an examination, do tests, and develop a working diagnosis. They then develop a management plan, start treatment, and monitor the patient’s progress. Chiropractors often treat problems related to the musculoskeletal system.

The manual treatment methods used by chiropractors range from stretching and sustained pressure to specific joint manipulations, which are usually delivered by hand and involve a quick and gentle thrust. The purpose of the manipulations is to improve joint motion and function. Manipulations are most commonly done on the spine, but other parts of the body may also be treated in this way.

Education and Licensure of Practitioners

• To practice in the United States, chiropractors must earn a Doctor of Chiropractic (D.C.) degree, pass the National Board of Chiropractic Examiners exam, and have a state license. Many states also require chiropractors to pass an exam about state-specific laws, and all states require practicing chiropractors to take continuing education classes.
• To enroll in a D.C. program in the United States, which typically takes 4 years to complete, students must have had at least 3 years of undergraduate education.
• Institutions that award the D.C. degree are accredited by the Council on Chiropractic Education, which is recognized as an accrediting agency by the U.S. Secretary of Education. In 2017, there were 15 accredited D.C. programs on 18 campuses.
• Chiropractic education includes classes in basic sciences, such as anatomy and physiology, and supervised clinical experience in which students learn skills such as spinal assessment, adjustment techniques, and making diagnoses.
• Some chiropractors complete postgraduate education in specialized fields, such as orthopedics or pediatrics.

The scope of chiropractors’ practice (that is, the types of services they are allowed to provide) varies from state to state. Health insurance plans may cover chiropractic, but coverage may be partial rather than complete.

What is spinal manipulation?

• Spinal manipulation is also called spinal manipulative therapy. It’s a technique where practitioners use their hands or a device to apply a controlled thrust (that is, a force of a specific magnitude or degree in a specific direction) to a joint of your spine. The amount of force can vary, but the thrust moves the joint more than it would on its own. Spinal manipulation is different from spinal mobilization, which doesn’t involve a thrust (and is performed within a joint’s natural range of motion and can be controlled by the patient).
• Most spinal manipulations are done by chiropractors (chiropractic treatment often involves spinal manipulation), although other licensed professionals including osteopathic physicians and physical therapists also do spinal manipulations.
• Spinal manipulation is one of the most common complementary health approaches used by adults and children in the United States, the 2012 National Health Interview Survey (NHIS) showed.

Why do people use spinal manipulation?

Among U.S. adults who used chiropractic or osteopathic manipulation, about 67 percent used it to treat a specific health condition, and 53 percent used it for wellness, the 2012 NHIS found. Specifically:

• 43 percent used it for general wellness or disease prevention
• 25 percent used it because it focuses on the whole person—their mind, body, and spirit
• 16 percent used it for improved energy
• 11 percent used it for better immune function
• 5 percent used it to improve memory or concentration.

Previous research found that people report positive experiences and reduced pain as a result of receiving spinal manipulation, the NHIS authors noted.

Who uses spinal manipulation and has usage changed?

Between 2012 and 2017, U.S. adults’ use of chiropractic care (which usually involves spinal manipulation) during the past year increased slightly, from 9.1 percent to 10.3 percent, a comparison of NHIS data from the two years showed. The data also show that women were more likely than men to see a chiropractor, and that adults between the ages of 45 and 64 were more likely than people aged 18-44 or 65 and over to have visited one during the past year. According to the same national survey (by the Centers for Disease Control and Prevention’s National Center for Health Statistics), non-Hispanic white adults were much more likely to visit a chiropractor (12.7 percent) than Hispanic (6.6 percent) or non-Hispanic black (5.5 percent) adults.

Among children, there was no significant difference in the use of chiropractic care between 2012 and 2017 (3.5 percent versus 3.4 percent). Older children (age 12 to 17) were more likely than younger ones (age 4 to 11) to have seen a chiropractor, but there was no significant difference in the use of chiropractic care between girls and boys. Non-Hispanic white children were more likely than non-Hispanic black or Hispanic children to have seen a chiropractor.

What are some of the pain conditions for which spinal manipulation has been used?

For Sciatica

• Sciatica is pain associated with the sciatic nerve, which controls muscles in the back of the knee and the lower leg; it also provides feeling to the back of the thigh, part of the lower leg, and the sole of the foot.
• Manipulation isn’t widely used to treat sciatica but it may help, a 2015 research review of a variety of sciatica treatments suggests. However, the studies had many limitations, the authors noted.
• In a 2014 study of 192 people with leg pain associated with back pain, participants who received spinal manipulation, personal instruction, and exercises had less pain after 12 weeks and used less medication a year later than participants who received only personal instruction and exercises. However, leg pain was the same for both groups after 1 year.

For Low-Back Pain

Many noninvasive treatments are available for low-back pain, and these include drugs and nondrug options. In its 2017 clinical guidelines, the American College of Physicians (ACP) suggests that spinal manipulation is one of a number of therapeutic options that may help people with acute or chronic low-back pain (although the ACP says the quality of the evidence is low).

• Spinal manipulation was better than placebo for immediate, short-term relief from acute or subacute low-back and neck pain, a 2010 research review concluded. Manipulation was also better than acupuncture for chronic low-back pain. However, the results of studies comparing spinal manipulation to massage, medication, or physical therapy were mixed.
• A 2011 review of 26 studies concluded that for chronic low-back pain, spinal manipulation works as well as other commonly recommended approaches, including exercise or physical therapy. However, the effect on pain was minimal.
• Twelve sessions of spinal manipulation may be the best “dose,” according to a 2014 NCCIH-funded study of 400 people with chronic low-back pain.
• In a 2014 study of 110 participants with chronic low-back pain, those who received spinal manipulation had less sensitivity to painful stimuli right after getting spinal manipulation, compared to people who got sham spinal manipulation. But after a couple of weeks the two groups had similar amounts of pain and disability, the study showed. The study was supported by NCCIH.
• The Agency for Healthcare Research and Quality (AHRQ) systematic review of noninvasive nonpharmacologic treatment for chronic pain reported that spinal manipulation was associated with slightly greater effects than sham manipulation, usual care, an attention control, or a placebo intervention in the short term (i.e., 1-6 months following treatment) and intermediate term (i.e., 6-12 months). The report concluded the strength of the evidence was low. In addition, the report concluded that there was no evidence of differences between spinal manipulation versus sham manipulation, usual care, an attention control, or a placebo intervention in short-term pain, but manipulation was associated with slightly greater effects than controls on intermediate-term pain. The standard of evidence was considered low for short-term effects and moderate for intermediate-term effects.
• The research on spinal manipulation for acute low-back pain is generally mixed and has many limitations.
  • Spinal manipulation is no more effective for acute low-back pain than sham (fake) spinal manipulation, or when added to another treatment such as standard medical care, a 2012 research review of 20 studies found. Spinal manipulation appeared to be safe when compared to other treatment options.
  • In a 2015 study of 220 people with acute low-back pain, participants who received physical therapy, which included spinal manipulation, fared no better than those who received standard care.
  • However, a 2015 NCCIH-funded study of 107 adults with recent-onset acute and subacute low-back pain found that those receiving spinal manipulation got greater short-term relief, compared to participants getting standard medical care. Furthermore, the study compared two different techniques—manual thrust manipulation (MTM) and mechanical assisted manipulation (MAM)—and found MTM led to greater short-term reductions in self-reported pain and disability than MAM or usual care.
  • A 2017 analysis examined data from 15 randomized controlled trials with almost 1,700 participants. The researchers concluded that spinal manipulative therapy can modestly improve pain and function in people with acute low-back pain.
• Results of a 2018 study with 750 active duty U.S. military personnel with low-back pain found that those who received chiropractic care in addition to usual care had better short-term improvements in low-back pain intensity and pain-related disability than those who only received usual medical care.

For Neck Pain

• For patients with acute neck pain, either spinal manipulation or home exercises appeared to be more effective than medication in the short and long term, an NCCIH-funded study of 272 patients showed in 2012. A 2015 research review that looked at results from 51 trials with 2,920 participants also reported that there’s weak evidence that spinal manipulation may provide short-term relief from acute or chronic neck pain.

For Headache

• For preventing migraines, spinal manipulation may be one of several complementary health approaches (including massage therapy) that’s as helpful as medications used for migraine prevention, but the research isn’t conclusive.
• The AHRQ systematic review of noninvasive nonpharmacologic treatment for chronic pain reported spinal manipulation therapy was associated with slight to moderate improvements in function compared to usual care on the Headache Impact Test and the Headache Disability Inventory (scale 0-100) and in pain over the short term (i.e., 1-6 months) in one trial. The standard of evidence was rated as low.

For Other Conditions

• Researchers have studied spinal manipulation for many other conditions, including fibromyalgia, children’s ear infections, chronic obstructive pulmonary disease (COPD), infant colic, and bedwetting, but there’s too little evidence to know if it helps with these problems.
• Spinal manipulation doesn’t help with asthma, hypertension, or menstrual pain, studies show.

Is spinal manipulation safe?

Spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects of spinal manipulation are temporary muscle soreness, stiffness, or a temporary increase in pain.

Serious complications, deaths, and delays in diagnosis of serious illnesses have been associated with spinal manipulation, including in children, but are very rare.

Strokes and Artery Tears

• A type of spinal manipulation that focuses on the neck has been linked to small, potentially dangerous tears in the artery walls in the neck, called cervical artery dissections (CAD). These tears are rare but can lead to a stroke. Any kind of sudden neck movement, such as playing sports, getting whiplash, and violent vomiting or coughing may also increase the risk of tears. The available evidence suggests that the incidence of CAD in people getting spinal manipulation is low, but patients need to be informed of this potential risk.

Spinal Manipulation and Pregnancy

• There are few reports of spinal manipulation causing problems during pregnancy or in the period after childbirth, a 2012 research review reported. The problems that have been reported ranged from mild, temporary pain to life-threatening injuries. Serious adverse events occurred only after cervical spinal manipulation.

NCCIH-Funded Research

NCCIH-supported studies have been investigating:

• The clinical impact spinal manipulation/chiropractic may have on chronic low-back pain in U.S. veterans
• How spinal manipulation compares with prescription drug therapy for long-term management of chronic low-back pain in older adults
• How to optimize spinal manipulation treatment protocols for patients with low-back pain
• Patients’ experiences and satisfaction with chiropractic care for chronic neck pain
• How to best provide chiropractic care for veterans with musculoskeletal pain and mental health disorders.

More to Consider

• In a 2017 clinical practice guideline, the ACP suggested that spinal manipulation remains a recommended treatment option for chronic low-back pain, saying that it is one of several options that show some evidence of effectiveness.
• Before selecting a chiropractor:
  • Ask about the chiropractor’s education and licensure.
  • Tell the chiropractor about all of your medical conditions.
  • Ask if the chiropractor has specialized training or experience treating your condition.
  • Ask about how many sessions you’ll need and typical out-of-pocket costs and insurance coverage. (Medicare Part B covers manual manipulation of the spine if it is determined to be medically necessary.)
  • Tell the chiropractor about any medications (prescription or over-the-counter) and dietary supplements you take. If the chiropractor suggests a dietary supplement, ask about potential interactions with your medications or other supplements.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.

Interventional pain management, or interventional pain medicine, is a medical subspecialty of pain medicine that diagnoses and treats pain with minimally invasive interventions that can alleviate pain and minimize the use of oral medications. Most interventional pain physicians offer interventional therapies for acute and chronic pain conditions as part of a comprehensive treatment program. Many interventional pain procedures have been around for decades, and they vary in their invasiveness. Image-guided interventional procedures (using ultrasound, fluoroscopy, and computed tomography) can greatly benefit comprehensive assessment and treatment plans by identifying the sources and generators of pain. Diagnostic and therapeutic interventional techniques can be valuable options prior to the initiation of extensive surgery, initiation of opioid treatment, or in concert with other treatment modalities. Additional research and more specific data establishing the clinical benefits of specific interventional procedures for specific pain conditions would be beneficial and can further identify various procedures for specific clinical conditions, particularly for certain populations, such as children. Many interventional pain procedures are available on an outpatient basis, which is vital to ensuring cost-effective access to care. Some minor interventional procedures can be performed in the primary care setting, while other more advanced procedures require specialty training. The measure of a successful outcome depends on whether the intervention is used to treat short-term, acute flares or is part of a long-term management plan that will depend on the individual patient and his or her unique medical status.

Epidural steroid injections (ESIs) deliver anti-inflammatory medication directly into the epidural space — the region outside the sac of fluid surrounding the spinal cord. Lumbar epidural injections treat back pain and radicular pain resulting from chemical irritation of nervous tissue by eliminating the inflammatory compounds mediating nervous tissue irritation in the epidural space. ESIs are one of the most common procedures in pain management and, in well-selected patients, can provide significant pain relief as part of a pain management plan. Although risks are associated with ESIs, they offer significant advantages to the patient — notably, they may potentially reduce health care costs, health care utilization, and the need for future surgical intervention. Transforaminal ESIs and selective nerve root injections are specialized approaches to the epidural space that target specific nerve root pathology.

Facet joint nerve block and denervation injection are common fluoroscopy-guided procedures for facet-related spinal pain of the low back and neck area in which local anesthesia with or without steroids is injected onto the medial branch nerves that supply these joints (medial branch blocks or less commonly directly into the facet joint). These injections are primarily diagnostic but can also be therapeutic, providing long-term relief. If there is only temporary relief, these nerves can be ablated by using radio-frequency (RF) ablation or cryoneuroablation. Facet pathology is a common cause of low-back pain as well as cervical pain caused by facet joint sprain (cervical whiplash) or degenerative changes and have proven effective in the treatment and diagnosis of cervical pain, axial back pain, and chronic spinal pain originating from facet joints. Compared with some intraspinal interventional treatments, procedures related to the facet joints can be simpler and carry lower risk.

Sacroiliac pathology is a type of spinal pain that can mimic herniated disc pain. These joints are not well imaged on standard magnetic resonance imaging views, and diagnosis is made by precise injections of local anesthesia and corticosteroids into the joint using fluoroscopy, ultrasound, or computed tomography, while long-term relief can often be obtained by denervating the nerves going to these joints.

Cryoneuroablation (also known as cryoneurolysis and cryoanalgesia) is a specialized interventional pain management technique that uses a cryoprobe to freeze sensory nerves at the source of pain and provide long-term pain relief. Cryoneuroablation is indicated for numerous persistent and intractable painful conditions, including paroxysmal trigeminal neuralgia, chest wall pain, phantom limb pain, neuroma, peripheral neuropathy, knee osteoarthritis, and neuropathic pain caused by herpes zoster.

Radiofrequency ablation. Conventional RF lesioning and pulse RF (PRF) are both ways to ablate certain nerves that have been identified as contributing to chronic pain syndromes, and they continue to have great value as a treatment modality in the management of a variety of pain syndromes. Furthermore, studies have shown that conventional RF provides benefits in appropriate patients. PRF uses short, high-voltage bursts of energy produced by needles inserted next to nerves to “stun” them, thereby blocking transmission of pain signals. Although more research is required to better understand both the exact mechanism of action of PRF and its efficacy in treating various chronic pain syndromes, PRF has already demonstrated its potential as a promising interventional modality in the treatment of cervical radicular pain, though there is no Current Procedural Terminology (CPT) code for the technique, and insurance typically does not cover it.

Peripheral nerve injections, commonly referred to as peripheral nerve blocks (PNBs), are injections of local anesthetic agents frequently mixed with anti-inflammatory steroid medication or clonidine for both diagnostic and therapeutic pain relief purposes. Administered either through a single injection or in a continuous infusion by catheter, PNBs are often employed in the perioperative and postoperative period for acute pain care. PNBs are advantageous in that they allow for quicker discharge times in ambulatory settings, less postoperative nausea and vomiting because less opioid medication is used, and improved patient satisfaction. There has been a growth in this area as part of improved perioperative pathways and the use and advancements in ultrasound-guided nerve blocks that allow for more effective anesthetic blocks. Ultrasound has also improved the ability to diagnose and treat peripheral neuropathies and nerve entrapments, and PNBs can also have a role in potentially diminishing or preventing the development of chronic pain syndromes such as CRPS, headaches, pelvic pain, and sciatica.

Sympathetic nerve blocks (SNBs), similar to PNBs, are injections of local anesthesia at the sympathetic nerve chain that can be used to diagnose or treat pain that involves the sympathetic nervous system. SNBs have been used to treat neuropathic pain, Complex Regional Pain Syndrome” 1 (reflex sympathetic dystrophy), and CRPS 2 (causalgia) as well as manage chronic abdominal, pelvic, and perineal pain.

What is massage therapy used for?

Massage therapy is used to help manage a health condition or enhance wellness. It involves manipulating the soft tissues of the body. Massage has been practiced in most cultures, both Eastern and Western, throughout human history, and was one of the earliest tools that people used to try to relieve pain.

What are the different types of massage?

The term “massage therapy” includes many techniques. The most common form of massage therapy in Western countries is called Swedish or classical massage; it is the core of most massage training programs. Other styles include sports massage, clinical massage to accomplish specific goals such as releasing muscle spasms, and massage traditions derived from Eastern cultures, such as Shiatsu and Tuina.

Do massages help pain?

Massage therapy has been studied for several types of pain, including low-back pain, neck and shoulder pain, pain from osteoarthritis of the knee, and headaches. Here’s what the science says:

Low-Back Pain

Several evaluations of massage for low-back pain have found only weak evidence that it may be helpful.

• The Agency for Healthcare Research and Quality, in a 2016 evaluation of nondrug therapies for low-back pain, examined 20 studies that compared massage to usual care or other interventions and found that there was evidence that massage was helpful for chronic low-back pain but the strength of the evidence was low. The agency also looked at six studies that compared different types of massage but found that the evidence was insufficient to show whether any types were more effective than others.
• A 2015 review of 25 studies with a total of 3,096 participants found that in both acute and chronic low-back pain, there were short-term improvements in pain after massage therapy. However, because the quality of the studies was low, the investigators who conducted the review concluded that they had “very little confidence” that massage is an effective treatment for low-back pain.
• Clinical practice guidelines (guidance for health care providers) issued by the American College of Physicians in 2017 included massage therapy as an option for treating acute/subacute low-back pain but did not include massage therapy among the options for treating chronic low-back pain.

Neck and Shoulder Pain

Massage therapy may be helpful for neck or shoulder pain, but the benefits may only last for a short time.

• A 2013 review of 12 studies (757 total participants) found that massage therapy was more helpful for both neck and shoulder pain than inactive therapies but was not more effective than other active therapies. For shoulder pain, massage therapy had short-term benefits only.
• A 2016 review of 4 studies conducted in the United States (519 participants) found that massage could provide short-term relief of neck pain if massage sessions were long enough and frequent enough.

Osteoarthritis of the Knee

The small amount of research that’s been done on massage therapy for osteoarthritis of the knee suggests that it may have short-term benefits in relieving knee pain.

• Of 6 studies that evaluated massage therapy for osteoarthritis of the knee (408 total participants), 5 found that it provided short-term pain relief. Two of the studies that showed pain relief (149 participants) involved the use of essential oils (aromatherapy massage).

Headaches

Only a small number of studies of massage for headache have been completed. These studies looked at different types of massage and different types of headache, and their results are not consistent.

• A 2016 study with 64 participants evaluated 2 types of massage (lymphatic drainage and traditional massage), once a week for 8 weeks, in patients with migraine. The frequency of migraines decreased in both groups, compared with people on a waiting list.
• In a 2015 study, 56 people with tension headaches were assigned to receive massage at myofascial trigger points or an inactive treatment (detuned ultrasound) twice a week for 6 weeks or to be on a waiting list. People who received either massage or the inactive treatment had a decrease in the frequency of headaches, but there was no difference between the two groups.
• A 2011 study evaluated the effect of adding hand massage to multimodal behavior treatment of migraine in 83 people. Hand massage had no effect on migraine frequency.

Restorative therapies include treatments provided by PT and occupational therapy (OT) professionals, physiotherapy, therapeutic exercise, and other movement modalities that are provided as a component of interdisciplinary, multimodal pain care.

Therapeutic exercise and its role in the treatment of pain is tied to the underlying diagnosis for the pain. Bed rest was scientifically recognized and prescribed as a treatment for low-back pain as recently as the 1980s, but high-quality scientific evidence has since emerged establishing the superiority of movement therapies over rest. The majority of pain-related PT guidelines exist for the treatment of spinal pain. In addition to improving physical functioning, a more contemporary biopsychosocial treatment approach to therapeutic exercise helps patients understand and overcome “secondary pathologies,” including fear of movement and anxiety that contribute to pain and disability.”

Transcutaneous electric nerve stimulation (TENS) has been applied to treat pain, but studies of its efficacy are lacking in number and design, with high risks of bias commonly reported. An evaluation of 49 systematic reviews, randomized controlled trials (RCTs), and observational studies found insufficient evidence to assess the effectiveness of TENS for acute low-back pain. More recent individual studies have investigated the effectiveness of TENS for postpartum pain, phantom limb pain, and knee osteoarthritis. Despite the overall limited evidence of efficacy, partially stemming from a lack of large RCTs, TENS is considered a safe self-care option for patients (with appropriate education).

Massage therapy can be effective in reducing pain. There are a variety of types of massage therapy, including Swedish, shiatsu, and deep tissue (myofascial release). In Swedish massage, the therapist uses long strokes, kneading, and deep circular movements. Shiatsu massage uses the fingers, thumbs, and palm to apply pressure. Deep tissue massage focuses on myofascial trigger points, with attention on the deeper layers of tissues.

Traction is a PT technique used to treat spinal pain. Review of the evidence has failed to demonstrate the clinical effectiveness of traction as an effective, evidence-based best practice; however, the field in general lacks high-quality RCTs that examine effectiveness of traction as an isolated treatment modality for low-back or neck pain.

Cold and heat have been used in the treatment of symptoms of a variety of acute and chronic pain conditions. The application of cold has long been a component of the RICE (rest, ice, compression, elevation) paradigm for the treatment of acute pain syndromes. Because it treats only symptoms, the effects and duration of this therapy are mitigated by the initial cause of the pain. For instance, cold therapy has been shown to decrease the pain of hip arthroplasty on the second but not the first or third day after surgery and did not decrease blood loss from the surgery. Evidence is not robust for all locations and types of pain, but significant evidence exists for the efficacy and safety of heat wraps in specific conditions, most notably for acute low-back pain. In fact, a review of non-pharmacologic therapies found that superficial heat had good evidence of efficacy for treatment of acute low-back pain. Another review found moderate evidence for heat wraps for both symptom and functional improvements.

Therapeutic ultrasound (TU) is thought to deliver heat to deep tissues for improved injury healing. A 2001 review concluded that there was little evidence that TU is more effective than placebo for pain treatment in a range of musculoskeletal conditions. More recent reviews of specific pain syndromes available through the Cochrane Database of Systematic Reviews reveal similar findings, although there is some evidence for TU in knee osteoarthritis.

Bracing has sometimes been discouraged in pain management because of fears of deconditioning and muscle atrophy. However, there is evidence that, for at least short periods of time, bracing (especially nonrigid bracing) may improve function and does not result in muscle dysfunction. Bracing should be part of the clinician tool box.

• Get into a comfortable position where you can relax your muscles. Close your eyes and clear your mind of distractions. You can sit up or lie down. If you’re lying down, you may want to put a small pillow under your neck and knees.
• Breathe deeply, at a slow and relaxing pace. Concentrate on breathing deeply and slowly, raising your belly with each breath, rather than just your chest.
• Next, go through each of your major muscle groups, tensing (squeezing) them for a few seconds and then letting go. Start at the top of your head and work your way down. Tense and relax your face and jaws, then shoulders and arms.
• Continue tensing and relaxing each muscle group as you go down (chest, lower back, buttocks, legs), ending with your feet. Focus completely on releasing all the tension from your muscles and notice the differences you feel when they are relaxed.
• When you are done, focus on the pleasant feeling of relaxation for as long as you like.

At a Glance

• Researchers found that yoga was as effective as standard physical therapy for treating moderate to severe chronic low back pain in people in underserved communities.
• The results suggest yoga may be useful as a treatment option for people with chronic low back pain.

Low back pain can range from a dull, constant ache to a sudden, sharp sensation that leaves you incapacitated. The pain can begin abruptly as a result of an accident or lifting something heavy, or it can develop over time due to age-related changes of the spine. For many people, low back pain persists longer than 3 months (chronic pain). For about 20%, chronic low back pain persists for more than one year.

Recent studies in people with mild to moderate chronic low back pain suggest that a carefully adapted set of yoga postures may help reduce pain and improve the ability to walk and move. Yoga stems from ancient Indian philosophy. As practiced today, it typically combines physical postures, breathing techniques, and meditation or relaxation. Most studies of yoga have been done with people from middle-class, white backgrounds. However, people who are from economically disadvantaged communities are disproportionally affected by chronic low back pain.

To study whether yoga helps alleviate pain and improve movement for people from underserved communities, a team led by Dr. Robert Saper at Boston University School of Medicine and Boston Medical Center studied 320 predominantly low-income, racially diverse adults with moderate to severe chronic low back pain. The researchers carried out a noninferiority trial, which is designed to assess whether a new treatment (yoga) is as effective as a current treatment (physical therapy). The study was funded by NIH’s National Center for Complementary and Integrative Health (NCCIH). Results were published online on June 20, 2017, in the Annals of Internal Medicine.

The participants were randomly divided into three treatment groups. One group received 12 weekly yoga classes designed specifically for people with chronic back pain; one received 15 physical therapy visits over 12 weeks; and one was given an educational book and newsletters about self-care for chronic low back pain. The researchers then continued to track the participants for an additional 40-week maintenance phase. During this phase, people in the yoga and physical therapy groups were randomly assigned to either continue to practice at home or with a professional—at yoga classes or physical therapy sessions.

The researchers found that all three groups reported improvement in physical function and pain reduction. However, people in the yoga and physical therapy treatment groups were significantly more likely than those in the education-only group to stop taking pain relievers after one year. These findings suggest that a structured yoga program may be a reasonable alternative to physical therapy for people with chronic low back pain.

“There are now a number of studies, including ours, that show that yoga is effective for chronic low back pain, but until ours those studies included mostly white and middle-class individuals,” Saper explains. “Chronic low back pain disproportionately impacts those who are economically disadvantaged. Therefore, we feel that it was important to test whether the yoga would be received well by an underserved population as well as being effective.”

—by Tianna Hicklin, Ph.D.