Chronic back pain, exercise helps a little. Not for acute back pain

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Chronic back pain, exercise helps a little. Not for acute back pain

25 Jul 2005 http://www.medicalnewstoday.com/medicalnews.php?

newsid=27962

Exercise therapy slightly decreases pain and improves physical

function in adults with chronic low back pain but appears to do

little for those with acute pain, according to a review of evidence

from a large number of studies on the subject.

In adults with acute back pain lasting up to three months, studies

suggest that exercise programs that gradually increase activity can

decrease absenteeism from work.

Chronic low back pain tends to be long-lasting and may come and go,

while acute pain hits suddenly and intensely -- after lifting a heavy

piece of furniture, for example.

Back pain is one of the most common occupational disorders in the

United States., according to the National Institute for Occupational

Safety and Health. It may be acute, lasting last less than 6 weeks;

subacute, lasting 6 to 12 weeks; or chronic, lasting more than 12

weeks.

" We found that adults with chronic low-back pain had modest

improvements in physical function and pain with exercise therapy, "

says lead investigator Jill Hayden.

With her colleagues, Hayden, a research fellow at the Institute for

Work & Health in Toronto, examined 61 studies of more than 6,000

adults with low back pain.

" The accumulated evidence supports a sea change that has occurred in

medicine, away from recommending prolonged bed rest and activity

restriction, " says Von Korff, ScD, a senior investigator at

the Center for Health Studies in Seattle. " We now recommend aerobic,

flexibility and strengthening exercises and sensible resumption of

normal activities as the worst pain subsides following an acute flare-

up of back pain. "

Another approach to low back pain treatment is transcutaneous

electrical nerve stimulation (TENS), a non-invasive treatment that

stimulates nerves through electrodes on the skin. This treatment has

been used for more than three decades.

But Lucie Brosseau, Ph.D., of the University of Ottawa, examined

previous studies to determine the effectiveness of TENS and found

only two studies of 175 patients that met standard criteria for

drawing conclusions. One study found a significant short-term benefit

for TENS treatment, but the larger, better quality study found no

effect.

" Despite the lengthy history of TENS it is not possible to draw

conclusions with confidence regarding its effectiveness for chronic

low back pain, " says Dennis C. Turk, Ph.D., a psychologist and pain

expert at the University of Washington in Seattle. " There may be some

place for TENS as a component of treatment for people with chronic

low back pain, but there is no evidence on which to base the

conclusion that it is useful as a solo modality for this population. "

Both reviews appear in the current issue of The Cochrane Library, a

publication of The Cochrane Collaboration, an international

organization that evaluates medical research. Systematic reviews draw

evidence-based conclusions about medical practice after considering

both the content and quality of existing medical trials on a topic.

Why doesn't exercise therapy appear to help with acute low back

pain? " Although the results for acute pain may appear

counterintuitive, the natural history of low back pain involves

resolution in a relatively brief time, " Turk says.

" Thus, the benefits of exercise would have to be substantially better

than the natural history, and this may simply be too high a hurdle, "

he adds. As with chronic pain, encouraging patients with acute back

pain to resume normal activities as soon as reasonable is probably

the best idea, Turk says.

Hayden JA et al. Exercise Therapy for Treatment of Non-specific Low

Back Pain; Khadilkar A et al. Transcutaneous Electrical Nerve

Stimulation (TENS) for Chronic Low-Back PainThe Cochrane Database of

Systematic Reviews 2005, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent

organization that produces and disseminates systematic reviews of

health care interventions and promotes the search for evidence in the

form of clinical trials and other studies of interventions. Visit

http://www.cochrane.org for more information.

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