Back pain is exceptionally common in the UK. Causes can be varied and may include muscle and ligament injury or strain, tissue inflammation and habitually poor posture. Typically it is the lower back that is affected since this is the area which supports the body’s weight. Our backs and spine are made up of a number of bones, nerves, muscles, tendons, ligaments, cartilage and other tissues. Any sort of damage or inflammation can cause chronic pain. Persistent and intense pain should always be checked with a doctor.
The pain medication usually used for the treatment of back pain is non-steroidal anti-inflammatory drugs, known as NSAIDs. Many individuals would rather not take pain medication regularly, you will be pleased to hear that there are many natural alternatives. It may also be helpful to see a physiotherapist or someone to help you with posture, such as a practitioner of the Alexander technique.
Alexander technique
The Society of Teachers of The Alexander Technique (STAT) the Alexander Technique as a “subtle and thoughtful discipline, but essentially practical and problem-solving. The Alexander Technique works through re-establishing the natural relationship between the head, the neck and the back – the “core” of the body that supports the strength of the limbs and which provides the structural environment for breathing and for the internal organs”
A well designed scientific study (1) was published in the British Journal of Medicine last year which evaluated the usefulness of Alexander technique lessons for chronic and recurrent back pain. One-to-one taught lessons in the Alexander technique from registered teachers was found to have long term benefits for patients suffering with chronic back pain. The study found that only six lessons were needed before a benefit was seen. To find a teacher of the Alexander technique visit the STAT website
Vitamin D
The sunshine vitamin was the hot topic last year and studies highlighting the importance of vitamin D for health continue to appear. Evidence is now building to suggest that vitamin D plays an important role in controlling back pain.
Already this year a paper has been published (2) by a family doctor which reviews 6 cases of chronic back pain. Vitamin D depletion and insufficiency was found in all patients. Pain improved, and in some cases completely resolved, after vitamin D supplementation/repletion. Vitamin D insufficiency is common here in the UK, we don’t tend to get enough sunlight exposure (especially in the autumn and winter months) to manufacture adequate levels of this nutrient. Doctors all over the world have started to recognise that supplementation is probably very important for a number, if not most, individuals in order to maintain healthy vitamin D levels throughout the year.
One study (3) involved 360 patients who had experienced low back pain that had no obvious cause for more than 6 months. 83% of the study patients were found to have an abnormally low level of vitamin D before treatment with vitamin D supplements. After treatment, clinical improvement in symptoms was seen in 100% of those that had a low level of vitamin D, and in 95% of all the patients.
A study published in the British Medical Journal (4) in 2005 called for the testing of vitamin D levels in patients seeking medical help for chronic back pain. The authors of the study “highlight the need for attending surgeons and physicians to be aware of the potential for vitamin D deficiency in their patients since failure to recognise this easily reversible problem may result in complications of treatment, including failure of spinal fusion surgery, additional morbidity, and the substantial costs of further surgery and hospitalisation. All patients with persistent, musculoskeletal pain are at high risk of the consequences of unrecognised and untreated vitamin D deficiency. Current clinical guidelines for managing chronic low back pain should include assessment of vitamin D status (by measuring serum 25-hydroxyvitamin D concentrations), together with advice on appropriate vitamin D supplementation in those found to be deficient”.
If you are suffering with back pain you and under the care of a doctor you may wish to discuss vitamin D supplementation with them. In light of all the recent and advancing evidence it seems wise that we consider a vitamin D supplement, providing around 500-800 IU per day, especially over the autumn/winter months when sunlight exposure on our skin is minimal. Some individuals may prefer to try and gain extra vitamin D from their diet. Unfortunately only small amounts of vitamin D are found in food sources such as oily fish e.g. mackerel, salmon and sardines (especially in canned varieties where the bones are soft and can be eaten) and eggs.
Omega 3 fatty acids
The omega 3 essential fatty acids are used in the body for the production of anti-inflammatory chemicals. These fats are found most abundantly in oily fish such as salmon, mackerel, sardines and trout. Vegetarian sources include flaxseeds and walnuts. Most people in the UK do not consume enough of these essential fats which are linked to a reduced risk of all kinds of conditions from heart disease, cancer, asthma, brain disorders and arthritic problems (to name but a few). As I mentioned at the start of this post NSAIDs are a commonly used anti-inflammatory medication for the reduction of back pain. However, these drugs are associated with risks such as gastric ulcers and many people prefer not to take this pain medication. The long chain omega 3 fatty acids found in oily fish could be beneficial due to their anti-inflammatory action.
There is one preliminary study (5) that took place in 2004 which involved patients who were suffering with neck or back pain. They were asked to take 1200mg of omega 3 fish oils per day for 4 months. Taking the fish oil supplement was associated with a reduction in overall pain. Larger, controlled studies are needed but there is certainly a lot of logic behind supplementation with omega 3 fatty acids in back pain associated with inflammation. A daily fish oil supplement containing 250-350mg EPA and 250-350mg DHA could prove useful. Vegetarians may want to consider a flaxseed oil supplement to provide 500-1000mg alpha linolenic acid daily.
Devil’s Claw
Devil’s Claw (Harpagophytum procumbens) is a herb that tends to grow naturally in South West Africa. The root of the herb has been traditionally used in Europe for hundreds of years and contains important plant chemicals such a harpagoside, harpagide and procumbide. Many studies have investigated the usefulness of this herb in the treatment of back pain.
A review paper (6) highlights two high-quality trials using Devil’s claw which found strong evidence for improvements in lower back pain. The daily dose of the herb was standardised to contain 50 mg – 100 mg harpagoside. Another high-quality trial found that the herb was as useful as rofecoxib (brand name Vioxx and Ceoxx), a prescribed NSAID, in the relief of lower back pain.
(1)Little P et al. 2008. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ. 337:a884, doi: 10.1136/bmj.a884
(2) Schwalfenberg G. 2009. Improvement of chronic back pain or failed back surgery with vitamin d repletion: a case series. J Am Board Fam Med. 22(1):69-74.
(3) Al Faraj S et al. 2003. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine. 28(2):177-179.
(4) Lewis P J. 2005. Vitamin D deficiency may have role in chronic low back pain. British Medical Journal. 331(7508):109.
(5) Maroon JC & Bost JW. 2006. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 65(4):326-31.
(6) Gagnier JJ et al. 2007. Herbal medicine for low back pain: a Cochrane review. Spine. 32(1):82-92.
Written by Ani Kowal
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I’m glad you mentioned the Alexander Technique – it did wonders for my (former!) backpain. Another very good site to learn more about it is at http://alexandertechnique.com