Nonpharmacologic Treatments for Low Back Pain

Uncommon Treatments For the Most-common Pain Complaint: 

Nonpharmacologic Treatments for Low Back Pain

Outcomes

Learners completing this activity report improved abilities in:

• Expanding treatment options to be discussed with patients with low back pain
• Using nonverbal cues to help assess pain

Outline

Chronic low back pain affects up to 37% of US adults. Globally, low back pain is associated with more disability than any other condition. This session reviews nonpharmacologic therapies ranging from the psychological, non-invasive, and minimally invasive. Each therapy will include evidence of efficacy, indications, contraindications and patient selection.

• Acupuncture
• Fascial Distortion Model (FDM) treatment
• Microcurrent therapy 
• Spinal Cord Stimulation (SCS)

Learning Objectives

As a result of participating in this activity, learners will be able/better able to:

• Implement new practices of assessing patients via verbal and nonverbal cues
• Provide care for patients with low back pain

Desirable Physician Attributes

• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
• Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
• Employ Evidenced-based Practice [IOM] Integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible
• Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
• Interpersonal and Communication Skills [ACGME/ABMS] Effective information exchange and teaming with patients, their families, and other health professionals

Pain management domains and core competencies

• 3. Treatment: How is pain safely and effectively treated?
  • Develops a pain treatment plan based on benefits and risks of available treatments
  • Identifies appropriate multimodal pain treatment options as part of a comprehensive pain management plan

Accreditation & Designation

Release date: This activity was released 8/28/2021.

Termination date: The content of this activity remains eligible for CME Credit until 8/27/2024, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity includes discussions and explorations of new and evolving topics. Such inclusion includes adequate justifications of statements based upon current science, evidence and clinical reasoning.

Disclosure of Financial Relationships

Neither the presenter, reviewers nor any other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, any financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Additional Reading

• Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., ... & Brodt, E. D. (2017). Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 166(7), 493-505.
• Richter, D., Karst, M., Buhck, H., & Fink, M. G. (2017). Efficacy of fascial distortion model treatment for acute, nonspecific low-back pain in primary care: A prospective controlled trial. Alternative therapies in health and medicine, 23(5), 24-32.
• Typaldos, S. (1994). Introducing the fascial distortion model. AAO Journal, 4(2), 14-18.
• Lee, W. J. (2019). Effect of fascial distortion model on the cobb’s angle in adolescents with idiopathic scoliosis. The Journal of Korean Physical Therapy, 31(1), 31-34.
• Manheimer, E., White, A., Berman, B., Forys, K., & Ernst, E. (2005). Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine, 142(8), 651-663.
• Brinkhaus, B., Witt, C. M., Jena, S., Linde, K., Streng, A., Wagenpfeil, S., ... & Willich, S. N. (2006). Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of Internal Medicine, 166(4), 450-457.
• Ernst, E., & White, A. R. (1998). Acupuncture for back pain: a meta-analysis of randomized controlled trials. Archives of Internal Medicine, 158(20), 2235-2241.
• Berman, B. M., Langevin, H. M., Witt, C. M., & Dubner, R. (2010). Acupuncture for chronic low back pain. New England Journal of Medicine, 363(5), 454-461.
• Koopman, J. S., Vrinten, D. H., & van Wijck, A. J. (2009). Efficacy of microcurrent therapy in the treatment of chronic nonspecific back pain: a pilot study. The Clinical journal of pain, 25(6), 495-499.
• Oh, H. J., Kim, J. Y., & Park, R. J. (2008). The effects of microcurrent stimulation on recovery of function and pain in chronic low back pain. Journal of Korean Society of Physical Medicine, 3(1), 47-56.
• Armstrong, K., Gokal, R., Chevalier, A., Todorsky, W., & Lim, M. (2017). Microcurrent point stimulation applied to lower back acupuncture points for the treatment of nonspecific neck pain. The Journal of Alternative and Complementary Medicine, 23(4), 295-299.
• Sdrulla, A. D., Guan, Y., & Raja, S. N. (2018). Spinal cord stimulation: clinical efficacy and potential mechanisms. Pain Practice, 18(8), 1048-1067.
• Dones, I., & Levi, V. (2018). Spinal cord stimulation for neuropathic pain: current trends and future applications. Brain Sciences, 8(8), 138.
• Gatchel, R. J., & Rollings, K. H. (2008). Evidence-informed management of chronic low back pain with cognitive behavioral therapy. The Spine Journal, 8(1), 40-44.
• Keefe, F. J. (1996). Cognitive behavioral therapy for managing pain. The Clinical Psychologist, 49(3), 4-5.
• Sveinsdottir, V., Eriksen, H. R., & Reme, S. E. (2012). Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain. Journal of Pain Research, 5, 371.