Self-Managing Low Back Pain: Does it Work?
A meta-analysis finds it brings little improvement, but experts say there is still a role for it.
Physicians often advise people with low back pain to manage it without expensive or invasive procedures – for instance, by self-monitoring symptoms and learning about their condition.
But according to a review article published recently in Arthritis Care & Research, this kind of self-management does little to improve pain and disability leading the researchers to conclude that people with low back pain may be better off trying other interventions, such as massage, which have been shown to lead to greater improvements.
Australian researchers conducted a meta-analysis of 13 individual studies that compared different treatments for low back pain (LBP). These studies included 3,063 participants with LBP that was not caused by something specific, such as an infection, cancer, fracture, inflammation or osteoarthritis.
The researchers defined self-management (sometimes called self-care) as sharing responsibility for a plan of care and self-monitoring and managing signs and symptoms. People might accomplish this by having discussions with their doctors and using information from sources such as brochures, websites, audiotapes or videotapes.
The meta-analysis found that on a scale of 100 points, individuals who self-managed their LBP had average improvements of only 3.2 points for pain and 2.3 points for disability within the first six months. The improvements were 4.8 points for pain and 2.1 points for disability after a minimum of 12 months.
"With such small improvements, it made us question whether or not managing low back pain on your own was worthwhile," says study co-author Vinicius Cunha Oliveira, a PhD candidate in the faculty of health sciences at the University of Sydney, in Sydney, Australia.
The research showed that self-management either had the same or fewer benefits than other nonmedical interventions, such as massage, acupuncture, yoga and exercise. However, self-management was more effective than a one-hour educational session on pain and disability at short-term follow up (less than six months) and on disability at long-term follow up (at least 12 months).
Finding the best ways to help improve low back pain is important because between 60 and 80 percent of the U.S. adult population has low back pain at some point. According to 2007 guidelines put out jointly by the American College of Physicians and the American Pain Society, LBP is the fifth most common reason for all doctor visits in the United States, with direct health care costs estimated (in 1998) to top $26 billion. These guidelines recommend the use of self-care when there is no serious underlying condition.
So how do the American and Australian guidelines square up? Roger Chou, MD, associate professor of medicine at Oregon Health and Science University in Portland and the co-author of the 2007 American guidelines, says there aren't major differences between the two country's guidelines. "Both recommend self-care and discourage invasive treatments and extensive testing for most people with LBP," Dr. Chou says.
However, the American guidelines defined self-care more broadly, and included interventions such as staying active, using warm packs, taking over-the-counter medications such as anti-inflammatory drugs, and doing home exercise programs. "None of these were included in the Australian [review article], even though there is evidence that they are helpful," Dr. Chou says.
Dr. Chou adds that, even though the benefits of self-management are small, he believes it is worthwhile because it is non-invasive and inexpensive. In addition, he says, there are very few effective interventions for LBP. "Even drugs that relieve pain only have an average of 10 to 20 points of improvement on a 100-point pain scale," Dr. Chou says. "So even if there is only a small effect, it still might be worthwhile."
Because national guidelines for low back pain strongly encourage it, the Australian authors were surprised that such little research had been done on self-management. "We found very few trials that tested self-management for low back pain," Oliveira says. "We were also surprised by the programs tested because they did not seem like the best choices. Better programs could produce better results."
Although its benefits appear to be small, Oliveira says he doesn’t think that people should stop self-managing their low back pain. Instead, more research should be done to see if any specific aspects of self-management might be more effective than others, such as group discussion or long-term follow-up sessions with doctors.
Other than self-care, what can patients with LBP do to feel better? "We know that staying active helps people recover faster than if they rest in bed," Dr. Chou says. "We also know that warm packs, over-the-counter medications, and home exercise programs can help with symptoms."
"The most important thing is to keep moving, if possible, and to understand that most LBP will get better without expensive or invasive treatments," Dr. Chou concludes.