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Back Pain
Introduction
Low-back pain is a common condition that can be difficult to treat. Spinal manipulation (The application of controlled force to a joint, moving it beyond the normal range of motion in an effort to aid in restoring health. Manipulation may be performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy.) is among the treatment options used by people with low-back pain in attempts to relieve pain and improve functioning. It is performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some conventional medical doctors. This fact sheet summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.
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Behavioral and Relaxation Approaches Consensus Statement
Introduction
Chronic pain and insomnia afflict millions of Americans. Despite the acknowledged importance of psychosocial and behavioral factors in these disorders, treatment strategies have tended to focus on biomedical interventions such as drugs and surgery. The purpose of this conference was to examine the usefulness of integrating behavioral and relaxation approaches with biomedical interventions in clinical and research settings to improve the care of patients with chronic pain and insomnia.Assessments of more consistent and effective integration of these approaches required the development of precise definitions of the most frequently used techniques, which include relaxation, meditation, hypnosis, biofeedback (BF), and cognitive-behavioral therapy (CBT). It was also necessary to examine how these approaches have been previously used with medical therapies in the treatment of chronic pain and insomnia and to evaluate the efficacy of such integration to date.To address these issues, the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health, convened a Technology Assessment Conference on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. The conference was cosponsored by the National Institute of Mental Health, the National Institute of Dental Research, the National Heart, Lung, and Blood Institute, the National Institute on Aging, the National Cancer Institute, the National Institute of Nursing Research, the National Institute of Neurological Disorders and Stroke, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.This technology assessment conference reviewed data on the relative merits of specific behavioral and relaxation interventions and identified biophysical and psychological factors that might predict the outcome of applying these techniques and examined the mechanisms by which behavioral and relaxation approaches could lead to greater clinical efficacy.The conference brought together experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, behavioral science, and neuroscience as well as representatives from the public. After 1-1/2 days of presentations and audience discussion, an independent, non- Federal panel weighed the scientific evidence and developed a draft statement that addressed the following five questions:What behavioral and relaxation approaches are used for conditions such as chronic pain and insomnia?How successful are these approaches?How do these approaches work?Are there barriers to the appropriate integration of these approaches into health care?What are the significant issues for future research and applications?The suffering and disability from these disorders result in a heavy burden for individual patients, their families, and their communities. There is also a burden to the Nation in terms of billions of dollars lost as a consequence of functional impairment. To date, conventional medical and surgical approaches have failed&emdash;at considerable expense&emdash;to adequately address these problems. It is hoped that this Consensus Statement, which is based on rigorous examination of current knowledge and practice and makes recommendations for research and application, will help reduce suffering and improve the functional capacity of affected individuals.