Chronic Back Pain, Exercise Helps A Little. Not For Acute Back Pain

Main Category: Back Pain
Article Date: 25 Jul 2005 - 14:00 PDT

email to a friend   printer friendly   opinions  

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 Michael 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.

Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
http://www.hbns.org

• Additional
• References
• Citations