If you have persistent neck or back pain , you might consider treating it with acupuncture, a massage or the care of a chiropractor, therapies that are often trumpeted as the solution to those chronic discomforts.
And you would not be alone. According to the National Center for Health Statistics, between 2002 and 2012, the number of people who received acupuncture increased by 36%, those who received therapy by means of massage rose in 38% and those that received attention from a chiropractor increased by 10.7%. (Chiropractic care was already the most common of the 3).
These complementary therapies are usually carried out by trained professionals and not doctors in medicine. People who advocate these healing methods claim that treatments can alleviate a variety of ailments, from migraines to insomnia. But more extensive studies have been done on back pain, which affects 8 out of 10 adults at some point in their lives , and neck pain that affects 30% to 50% of adults at a certain time. .
Do they work? Are they safe? We talk to experts and analyze the investigation to find out. Here’s how it might make sense to try them and when to stay away.
The founder of modern chiropractic care, a nineteenth-century Iowa resident, believed that chiropractic manipulation, or “realigning” the spine by pressing on his joints, could cure all kinds of conditions. And some chiropractors still offer services for conditions such as asthma and high blood pressure, although there is no solid evidence that chiropractic treatment helps in these cases. But most focus on skeletal and muscular problems, especially pain in the lower back, neck and shoulders, as well as related headaches.
Chiropractic care also improved participants’ short-term physical functions, such as their ability to climb stairs or bend over. “The bad news is that, for chronic and constant back pain, even the best therapies only result in mild to moderate relief,” says Dr. Roger Chou, MD, a professor of medicine at Oregon Health & Science University, who studies back pain. When it comes to neck pain, a study of 181 people published in the Annals of Internal Medicine found that receiving regular chiropractic care (approximately once a week for 12 weeks) could decrease discomfort, even better than acetaminophen and anti-inflammatory medications. Non-steroidal
Some research also suggests that chiropractic manipulation may work just like medications for migraine headaches.
“For chronic neck or back pain that is not accompanied by symptoms that require medical attention, such as bowel or urinary problems or weakness, numbness or tingling in an arm or leg, consider chiropractic manipulation seems reasonable,” says Chief Medical Adviser to Consumer Reports, Dr. Marvin M. Lipman, MD But it is not an option that is risk free. “It can cause temporary headaches and, rarely, serious problems such as worsening pain from a deviated disc,” he says.
As documented in early drawings in Egyptian tombs and in Chinese scriptures dating back to 2700 BC, massage involves a variety of techniques to rub the body and relieve muscle tension and pain.
On average, massage therapy also seemed to relieve discomfort better than treatments such as acupuncture, traction and relaxation exercises. Even more important, when compared to not receiving any treatment or receiving a placebo treatment, massage improved functions, such as the ability to walk, sleep and other important components of daily life.
The studies reviewed were small (124 people, on average), says Dr. Andrea Furlan, MD, Ph.D., lead author of the report and scientist at the Institute for Work & Health in Toronto. “Actually I think massage is effective,” he said. “But, we need larger, better designed clinical trials before we can be sure.”
So, how could a massage relieve discomfort? Scientists have not identified a mechanism, but believe that massage could stimulate nerves that mute pain signals. Another theory suggests that massage may activate the release of hormones that reduce pain, known as endorphins.
Research suggests that massage may have benefits beyond pain relief. For example, an analysis of 17 clinical trials in 2010 found that it could help relieve depression. “Trying a massage for back pain probably will not hurt, and it could help,” says Lipman. But if you try, inform your medical professional in advance about the medical conditions you have and the medication you take. The massage is not appropriate for everyone. People who take anticoagulants, such as warfarin (Coumadin or generics), for example, should avoid deep tissue massages, since intense pressure could cause bruising.
Several people who use acupuncture for chronic pain report benefits. For example, an analysis of 29 studies with a total of 17,922 participants with neck and back pain, osteoarthritis, chronic headache and shoulder pain, found that people with those conditions experienced significantly more relief with acupuncture than those who did not. They received no treatment. People also reported less pain after real acupuncture than they did after fake acupuncture (for example, when they inserted needles at different points that were not acupuncture points), but the differences were small.
A possible reason for the benefits of acupuncture: Studies show that it causes us to release the endorphins that make us feel good and that eliminate pain. “Acupuncture, real and false, could also make you feel better simply because you feel cared for or because you expect it to work: what is known as the placebo effect,” says Lipman.
For back and neck pain, acupuncture is safe, as long as a trained professional uses sterile needles, such as disposable single-use needles. But omit it for conditions that do not treat any pain; there is no conclusive evidence that he will help you.
Are these treatments even more effective than conventional treatments, such as over-the-counter pain relievers? Experts say it is not clear. What they do know is that, for conventional and complementary pain treatments, what works for one person will not necessarily work for another.
“The key,” says Chou, “is to find the treatment that works for you and to consult with a therapist who is concerned about the function, not just the pain relief, and to help you return to the activities that most they matter to you in life.
Training. Most states regulate massage therapists and licensing requirements may vary from state to state. It is better to work with a professional who is certified by a national organization such as the National Certification Board for Therapeutic Massage ( National Certification Board for Therapeutic Massage and Bodywork).
Medical coverage? Some health insurance policies cover a limited number of massages if prescribed by a doctor, but massage therapy is not covered by Medicare.
Training. All states require chiropractors to obtain a doctor of chiropractic (DC) degree from an educational program accredited by the Chiropractic Board of Education (CCE). Chiropractors are also required to pass an exam administered by the National Board of Chiropractic Examiners to obtain their license.
Medical coverage? The treatments are usually covered by health insurance, including Medicare Part B, which pays 80% of the cost after your deductible.
Training. Almost all states require at least 1,600 hours of training and that acupuncturists are certified or pass an examination by the National Certification Commission for Acupuncture and Oriental Medicine.