Back pain future or investigational therapies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Future or Investigational Therapies

Treatments with Uncertain Benefit

  • While some citations report limited benefit from injections, such as epidural steroid injections, facet joint injections, or prolotherapy they still enjoy considerable support among the majority of patients and clinicians.[1][2] Arguments against those citations with negative outcomes include the extreme difficulty in finding literature that has consistent and clearly defined patient populations while accounting for the multifactoral nature of back pain.
  • Cold compression therapy is advocated for a strained back or chronic back pain and is postulated to reduce pain and inflammation, especially after strenuous exercise such as golf, gardening, or lifting. However, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded "The evidence for the application of cold treatment to low-back pain is even more limited, with only three poor quality studies located. No conclusions can be drawn about the use of cold for low-back pain".[3] Despite this, cryotherapy is inexpensive, easily tolerated and been used with high success for decades in patients with numerous kinds of musculoskeletal conditions.
  • Bed rest is rarely recommended as it can exacerbate symptoms,[4] and when necessary is usually limited to one or two days. Prolonged bed rest or inactivity is actually counterproductive, as the resulting stiffness leads to more pain.
  • Electrotherapy, such as a Transcutaneous Electrical Nerve Stimulator (TENS) has been proposed. Two randomized controlled trials found conflicting results.[5][6] Despite the fact the the article by Walsh NE made use of "sham TENS" (essentially a TENS unit that could not be felt compared to a second unit that was off) the expected negative outcome study results have been cited by the Cochrane Collaboration to conclude that there is inconsistent evidence to support use of TENS.[7] In addition, spinal cord stimulation (SCS), where an electrical device is used to interrupt the pain signals being sent to the brain and has been studied for various underlying causes of back pain. While SCS still enjoys limited acceptance, it is expensive, requires lifelong monitoring and is not without complication.
  • Inversion therapy may be useful for temporary back relief due to the traction method or spreading of the back vertebra's through (in this case) gravity. The patient hangs in an upside down position for a period of time from ankles or knees until this separation occurs. The effect can be achieved without a complete vertical hang (90 degree) and noticeable benefits can be observed at angles as low as 10 to 45 degrees.


  1. Nelemans P, de Bie R, de Vet H, Sturmans F. "Injection therapy for subacute and chronic benign low back pain". Cochrane Database Syst Rev: CD001824. PMID 10796449.
  2. Yelland M, Mar C, Pirozzo S, Schoene M, Vercoe P. "Prolotherapy injections for chronic low-back pain". Cochrane Database Syst Rev: CD004059. PMID 15106234.
  3. French S, Cameron M, Walker B, Reggars J, Esterman A (2006). "A Cochrane review of superficial heat or cold for low back pain". Spine. 31 (9): 998–1006. PMID 16641776.
  4. Hagen K, Hilde G, Jamtvedt G, Winnem M. "Bed rest for acute low-back pain and sciatica". Cochrane Database Syst Rev: CD001254. PMID 15495012.
  5. Cheing GL, Hui-Chan CW (1999). "Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain". Archives of physical medicine and rehabilitation. 80 (3): 305–12. PMID 10084439.
  6. Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S (1990). "A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain". N. Engl. J. Med. 322 (23): 1627–34. PMID 2140432.
  7. Khadilkar A, Milne S, Brosseau L; et al. (2005). "Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain". Cochrane database of systematic reviews (Online) (3): CD003008. doi:10.1002/14651858.CD003008.pub2. PMID 16034883.

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