I am always amazed when I meet a person whose doctor refuses to prescribe physical therapy for a back or neck problem. But the truth is, there are not a lot of high quality studies that investigate how non-invasive treatments stack up against one another and/or against surgery. (My guess is, these treatments don't benefit the bottom line of pharmaceutical and medical device companies, and as such less money goes to fund them...)
A 2009 review on the effectiveness of physical therapy treatments for chronic non-specific low back pain was published in the European Spine Journal in 2010. This review looked at studies that compared a number of common treatments such as back exercise, back school, TENS, low level laser, massage, behavioral treatment such as cognitive behavioral therapy and more.
The results were pretty dismal, and at least for back exercise, in my opinion, not fully reflective of the truth. The researchers found that results from exercise therapy were approximately equivalent to doing nothing. But, when compared with going to the the doctor, exercise relieved more pain and reduced more disability in the short term. So at least there's that perk.
If you're thinking about getting a TENS unit to help deal with the pain, think again. The review found that TENS was no different from sham TENS treatment nor active treatment.
The review also found only low quality evidence for multidisciplinary approach to back pain treatment as compared to doing nothing. This low quality evidence was for short term pain relief and decreased disability.
Related: Pain Management Medicine - A Multi-Disciplinary Approach
The one silver lining in this review was that behavioral therapies scored well. The researchers found that behavioral therapy of all types helped reduce the intensity of pain. Just the same, researchers are still debating the effectiveness of CBT for back pain, specifically.
- What to Expect at a Cognitive Behavior Therapy Session
- What are Distorted Thoughts?
- ACT for Chronic Pain
van Middelkoop, M, et. al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011. Accessed Sept 2012.