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Treating Low Back Pain Earlier in Life

November 29, 2018

By Kevin Coss

As a society, we’re starting to pay more attention to low back pain. The mounting public health crisis around opioid addiction, the huge costs of procedures to diagnose pain, and the aggressive treatment options like spinal surgery have spurred the search for alternative ways to treat this condition, which affects at least 40 percent of adults at some point in their lives.

But what about their younger counterparts? Research shows low back pain is developing with increasing frequen­cy in adolescents, and many carry it on into adulthood.

“Clinicians and researchers are measuring pain occurrence more frequently and tracking it more closely,” says Roni Evans, D.C., M.S., Ph.D. “As a part of that process has come the growing recognition that kids and adolescents are experiencing low back pain, too—it’s not just happening in adults.”

Evans, director of the Integrative Health & Wellbeing Research Program in the University of Minnesota’s Earl E. Bakken Center for Spirituality & Healing, is lead author on a recently published study that shows encouraging signs for adolescents suffering from this condition. The study, funded by the US Department of Health and Human Services and published this summer in the journal PAIN, found that children ages 12 to 18 could benefit from a combination of two nondrug therapies currently used to treat low back pain in adults.

Advancing integrative healthcare through research is a key part of the Center’s mission, and testing nondrug treatments for low back pain in adolescents was an area ripe for study—very little research had been done. Finding effective treatment alternatives could empower adolescents to take control of their health while limiting or avoiding the use of potentially addictive medications.

It’s easy to imagine how low back pain hinders physical activities, like lifting something heavy or standing for long periods, but the condition can have many more subtle consequences. For example, adolescents may feel isolated or frustrated trying to “fit in” with friends and peers who can’t see, and therefore can’t understand, the pain they feel. Pain can also hinder their ability to concentrate or disrupt their sleep, making it harder to manage school and social obligations.

“Psychologically, it can be hard on adolescents when they are not able to do the things they want and need to do,” Evans says. “Even pain that isn’t very severe can be taxing when it lasts for long periods of time.”

Why is it important to study low back pain in adolescents, rather than just using treatments suggested for adults? Adolescents’ bones, joints, and muscles aren’t just smaller versions of adults’, Evans explains. They are at a different level of biological development, meaning that a given treatment may not help younger people in the same way as adults. Adolescents are also at a different stage of psychological development, which means they may use different methods for coping with and managing pain.

Combined Therapies, Lasting Results

In the study, the researchers examined two groups of adolescents with low back pain over the course of a year. The first group performed supervised exercises designed to stretch and strengthen the body’s core muscles. The second group did these same exercises, but also received a treatment called spinal manipulation therapy. This technique, commonly used by chiropractors, physical therapists, and other licensed healthcare practitioners, involves applying a controlled force to joints in the spine with the goal of restoring motion and relieving pain. Both supervised exercise and spinal manipulation therapy can be used for new cases of low back pain as well as longer-standing problems.

Immediately following their three months of treatment, both groups experienced less low back pain, and there had been an 80 percent overall drop in medication use. Members of the group that received spinal manipulation however, saw a much greater reduction in the intensity of their pain, with 30 percent of them feeling 75 percent less severe pain,1 compared with just 14 percent of the exercise-only participants.2 A full three months after treatment ended, the groups were still feeling the benefits with 70 percent of the second group feeling 50 percent less severe pain,3 compared to 40 percent of the exercise-only group.4

Craig Schulz, D.C., M.S., assistant professor at the Center and an investigator on the study’s research team, said the results were an encouraging sign. “Providing patients the option to gain control of pain with spinal manipulation therapy, along with complementary interventions such as exercise and self-management education, is a promising approach to reduce or substitute for medication use,” Schulz says. “These therapies can aid individuals in developing an understanding for how to manage low back pain on their own.”

A Path to Pain Management

It’s too early to say for certain that a combination of spinal manipulation therapy and exercise will benefit all adolescents with low back pain. More research needs to be done to see if the outcomes of this first study can be replicated in further research. Still, Evans hopes health practitioners will recognize that there are safe and potentially effective alternatives to drug therapies out there, and will consider referring their younger patients to chiropractors and physical therapists.

“It’s really important that scientists continue to explore these and other nondrug approaches to helping adolescents with low back pain,” she said. “I think the future lies in teaching kids and adolescents how to respond to and manage their pain in ways that will best help them physically, psychologically, and socially.” +++

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Calling Adults with Low Back Pain

As researchers at the Center make headway into new low back pain treatments in adolescents, they are also delving deeper into strategies for helping adults—and figuring out how to better integrate nondrug treatments into the healthcare system.

A research team led by Professor Gert Bronfort, D.C., Ph.D., in collaboration with researchers from the University of Washington and the University of Pittsburgh, is now recruiting participants for a multisite clinical study that aims to discover the best strategies for addressing the physical, mental and social challenges that come with short-term low back pain to help prevent it from becoming a chronic condition. The study, called “PACBACK,” is supported by federal funding from the National Center for Complementary and Integrative Health.

Participants will receive two months of low back pain treatment, followed by 10 months where researchers check in periodically to gauge how much pain they are feeling. The treatment techniques will consist of either spinal manipulation therapy; self-management techniques including relaxed breathing, imagery, exercise, and lifestyle changes; a combination of these two approaches; and conventional medical care.

While evidence has suggested for nearly a decade that nondrug treatments can help adults with low back pain, healthcare practitioners have been slow to take advantage of these methods in their regular practice. In addition to discovering effective treatment options, the study aims to understand the perceptions that surround therapies like spinal manipulation and self-care to figure out how these treatments can be better integrated into practitioners’ regular practice.

The PACBACK study is now seeking participants ages 18 and up with low back pain.

For information on participating, visit pacback.org.

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The Bakken Center for Spirituality & Healing blog covers a range of integrative health and wellbeing topics. For more information about our blog, contact us at csh@umn.edu