Naturopathic and Integrative Care for Back and Musculoskeletal Pain: What Is Known
What the American College of Physicians guideline, Cochrane and BMJ reviews and one naturopathic trial found for low back pain, with red-flag symptoms that need urgent care.
Content last updated . This page has not been medically reviewed.
Some back pain needs emergency care. The NHS says to get emergency help for back pain together with pain, tingling, weakness or numbness in both legs, or a loss of feeling around the genitals or anus. [1] The same applies to changes in bladder or bowel control, such as difficulty peeing or peeing or pooing yourself. [1] In the United States, call 911 rather than driving yourself. [1] See a doctor promptly if back pain comes with unexplained weight loss. [1] This page is general information, not medical advice.
Most back pain improves, but not always
The NHS says back pain usually improves within a few weeks but can sometimes last longer or keep coming back. [1] The American College of Physicians (ACP) guideline notes that most patients with acute or subacute low back pain improve over time regardless of treatment. [2] That is why testing a treatment fairly is hard, and why the comparison group in a trial matters.What guidelines recommend first
For chronic low back pain, the ACP guideline says clinicians and patients should initially select non-drug treatment such as exercise, multidisciplinary rehabilitation, acupuncture or mindfulness-based stress reduction (moderate-quality evidence), with several others including tai chi, yoga and spinal manipulation at low-quality evidence. [2] NCCIH describes low-quality evidence that acupuncture, massage therapy and spinal manipulation may help acute low back pain. [3]Who offers naturopathic and integrative care for pain
NCCIH describes licensed naturopathic physicians as trained at accredited naturopathic medical schools and traditional naturopaths as trained in various non-accredited programs. [4] Licensing varies across U.S. states and territories. [4] Physical therapists, chiropractors, massage therapists and acupuncturists work under their own rules. See naturopathic care compared with other professions and acupuncture alongside physical therapy and chiropractic.The naturopathic back pain trial
A randomized trial of 75 postal employees with low back pain for longer than six weeks compared 12 weeks of naturopathic care with standardized physiotherapy. [5] Naturopathic care included dietary counseling, deep breathing relaxation techniques and acupuncture, while the comparison group received education and instruction on physiotherapy exercises from a booklet. [5] The abstract reports significantly lower back pain on the Oswestry disability questionnaire with naturopathic care. [5]How to read this: the comparison was written advice and exercise instruction, not an equally intensive treatment, and participants could not have been unaware of which they got. It was one trial in one workplace setting. A separate economic evaluation in a sample of 70 warehouse workers reported reduced societal costs. [6] Evidence label: promising but limited. A scoping review of whole-system naturopathic research lists musculoskeletal pain among conditions where its authors judged naturopathic medicine effective. [7] See whole-system naturopathic care trials.
Single approaches checked
| Approach | What the sources say | Label |
|---|---|---|
| Yoga, chronic low back pain | Cochrane: low-certainty evidence of a small, clinically unimportant improvement in function; trials unblinded and at high risk of bias [8] | Mixed |
| Spinal manipulation, chronic low back pain | BMJ meta-analysis of 47 trials: similar effects to other recommended therapies [9] | Promising but limited |
| Acupuncture | NCCIH: low-quality evidence for acute pain; serious complications rare [3] | Promising but limited |
| Massage | Low-quality evidence for acute pain [3] | Promising but limited |
On safety, yoga was associated with more adverse events than no exercise, though perhaps not more than other exercise. [8] Most adverse events in spinal manipulation trials were musculoskeletal, short-lived and mild to moderate, but only about half of the studies examined adverse events at all. [9] NCCIH says these practices have good safety records when used appropriately, though pregnancy and other health conditions may change the risk. [3]
More detail on each approach: acupuncture for back and neck pain, yoga evidence by outcome and massage evidence by goal.
Supplements and injections
Herbal and supplement products marketed for pain are covered in botanical medicine in naturopathic practice. Proper evidence not found in the sources we read for a supplement or injection protocol with good trial support for chronic low back pain. Topical cayenne is the one herbal preparation NCCIH says may help relieve low back pain. [3]Questions to ask
Ask who will rule out serious causes first, what the plan involves, how many visits are expected, whether products are sold, and how progress will be measured. See questions to ask a naturopath or integrative practitioner.Frequently asked questions
Does naturopathic care help chronic low back pain?
One randomized trial found more improvement than physiotherapy booklet advice, but it was a single small study with an unmatched comparison. [5]
What do guidelines recommend first for chronic back pain?
The ACP guideline suggests starting with non-drug treatments such as exercise, multidisciplinary rehabilitation, acupuncture or mindfulness-based stress reduction. [2]
Is yoga good for back pain?
Cochrane found small improvements in function and pain compared with no exercise that it called clinically unimportant. [8]
Is spinal manipulation safe?
Most adverse events in trials were mild and short-lived, and the review advises clinicians to inform patients of the potential risks. [9]
When is back pain an emergency?
With leg weakness or numbness in both legs, numbness around the genitals or anus, or bladder or bowel changes, get emergency help. [1]