NUR2300 Systematic Review: Complementary Therapies for Back Pain

This report provides a systematic review of the effectiveness of complementary therapies, such as acupuncture, physiotherapy, massages, and hydro-massage, compared to traditional medications in managing chronic back pain in adults over 50 years of age. It evaluates research articles focusing on non-pharmacological interventions like Tai Chi, spinal manipulation, and exercise therapies, assessing their impact on pain relief, functional ability, and quality of life. The review highlights the potential benefits of these therapies as alternatives or complements to traditional medicine for long-term symptom management, while also addressing limitations in existing research and suggesting areas for future investigation. The assignment adheres to the NUR2300 Evidence-Based Nursing Practice guidelines.

Running head: SYSTEMATIC REVIEW OF CHRONIC BACK PAIN
Systematic Review of Chronic Back Pain
Name of the student
Name of the university
Author note

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Table of Contents
Step 3: Research report..............................................................................................................2
Research Question......................................................................................................................2
Evaluation of research................................................................................................................2
Research Topic...........................................................................................................................3
Literature Review.......................................................................................................................4
Recommendations for Future Research.....................................................................................6
Step 2: Annotated Bibliography.................................................................................................7
References..................................................................................................................................9

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Step 3: Research report
Research Question
There are a number of chronic conditions listed under the Australian Institute of
Health and Welfare. One of such conditions includes chronic back pain in adults over the age
of 50 years (P). For treatment of this condition, traditionally several pain medications (C)
have been implemented for decades. However, the medications have failed to provide a long-
term relief from the symptoms. Therefore, currently various alternative therapies (I) are being
suggested which may result in effective management of the symptoms (O). Therefore, the
research question is: Effect of complementary therapies over traditional medicines in chronic
back pain in adults over the age of 50 years.
Evaluation of research
Logical and stepwise description of the study design is one of the major strength of
the literature by Yeganeh et al. (2016). The systematic search with five major databases:
Medline, CINAHL, Science Direct, CAJ Full-text Database and Cochrane database, has been
proven to be beneficial for the searches. The literature search was limited to articles
published up to May 2013 and the language was set at Persian and English. Selecting
literatures that were based on randomized control trials enabled the authors to do a better
assessment. Uses of a variety of search terms such as non-pharmacologic, complementary
and alternative medicine and low back pain have helped the reviewers to gain 415 hits at
once. Exclusion was done based on abstract, duplication and detailed analysis of the full text
and finally 7 articles were selected. Using two independent reviewers for data extraction and
Cochrane Back Review Risk of Bias criteria, reduced the chances of bias. The homogeneity

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present in the final 7 articles made the researchers perform a meta-analysis on them. The
systematic review was able to establish the favorable effects of acupuncture, acupressure and
chiropractic on self-reported pain and LBP in adults.
Research Topic
The research topic is studying the effects of different kinds of complementary
therapies that have the potential to effectively manage the condition of chronic back pain in
people over the age of 50 years (Qaseem et al., 2017). The health outcomes include the
actions taken to improve the chronic conditions and not the ones that are required to be
implemented. It allows flexibility that helps in developing strategies and implementing those
strategies or policies to provide specific health services that result in a positive patient
outcome (Chaparro et al., 2013). Complementary therapies include physiotherapy,
acupuncture, massages, hydro-massage, Tai chi or spinal manipulation therapies. For decades
the condition of chronic back pain has been treated with medications which could not result
in any permanent relief from the disease. Modern treatment methods have been proven to be
effective in providing long-lasting relief from the pain. Such as acupuncture, which is a
traditional Chinese therapeutic technique, involves inserting thin needles at specific nerve-
points or acupoints to release endorphin and thereby block pain sensations (Eccleston et al.,
2014). Spinal manipulations involve massaging of the soft tissues around the spinal area or
around the ligaments and the vertebrae by chiropractors and osteopathic physicians,
respectively, to reduce the back pain in adults. Also the most talked about exercise therapy
Tai chi is used for effective management of chronic back pain. This includes movement in
slow motion and shifting of weight to gradually improve the musculoskeletal strength and the
stability of the joints. Hydrotherapy promotes blood circulation through the muscles by using

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different water pressure for helping with the stiffness in spine and thus soothes the lower
back pain effectively (Licciardone et al., 2013).
Literature Review
The principle finding of Yeganeh et al. (2016) is the suggestion based on rigorous
systematic review that compared to any other treatment for lower back pain (LBP) the non-
pharmacological interventions such as acupuncture, acupressure and chiropractic are the most
effective in reducing the chronic LBP in adults. The article has provided sufficient evidence
that acupuncture is an effective short-term clinically relevant intervention but lack of
continuity across the literatures considered did not allow the authors for making a pooled
estimate of the intervention. The authors have also explored the effectiveness of the spinal
manual therapy (SMT) and concluded that it is advantageous over other therapies including
physical therapies, ultrasound or electrotherapies. In this literature review the search process
included databases such as CINAHL, MEDLINE and EMBASE. Also, no clinical trials were
found through the search process which is quite common in any systematic review (Maher,
Underwood & Buchbinder, 2017). Along with these, the strict adherence to the chronic non-
specific low back pain (CNSLBP) limited the number of findings, since many articles
included a mixed population of patients who suffered from back pain. The primary outcomes
of the review that were consistent with self-reported pain and back-pain specific functional
status, were somewhat satisfactory for the authors. Thus, according to the article, implication
of acupuncture and spinal manual therapy can be most effective for treating chronic low-back
pain (LBP) and along with these, chiropractic and acupressure have also proven to be
beneficial compared with other treatment options. These techniques can be implied in nursing
practice for better patient outcomes (Holtzman & Beggs, 2013).

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In another study by Paull (2017), the effectiveness of complementary and alternative
medicine (CAM) foe relieving LBP has been discussed. The study suggests that pain
management in case of older adults can be accomplished with the help of combination
therapies such as combining conventional analgesics with acupuncture or transcutaneous
electrical nerve stimulation (TENS). The author has also implied that aromatherapy massage
can be helpful for older adults dealing with dementia and may help reducing the sense of
agitation and anxiety in them. To cope with dyspnea, acupuncture, acupressure and
rebreathing trainings can be helpful (Lyons et al., 2013). The author has suggested several
food supplements that have been proven to manage pain in older adults.
In the article by Lizarondo (2016) it has been identified that implication of several
physiotherapy can help reduce chronic back pain in adults. Exercises that effectively reduce
the severity of LBP include trunk coordination or stabilization exercises, strengthening and
endurance exercises, flexion exercises and sling exercise. The authors have mentioned
several other interventions that can be implied to relieve the LBP such as spinal thrust
manipulation and non-thrust mobilization procedures, lower quarter nerve mobilization
techniques, intermittent or static lumbar traction. Due to lack of evidence or presence of
many arguable reports, the interventional methods of ultrasound, low level laser therapy,
TENS, superficial heat or cold therapies and lumbar support could not be recommended by
the authors (Mafi et al., 2013). Educating the patients about LBP management and their
proper counseling is essential for moving them towards a healthier lifestyle. The article also
evaluated the effectiveness of massage in combination with other therapies. Most importantly
it suggests that ultrasound and traction should not be used as intervention for treating chronic
LBP.
In the study by Dias (2018) it has been found that that intervention of Tai Chi, a non-
pharmacological mind-body exercise therapy, can be effective in reducing chronic low back

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pain (LBP) in adults. If LBP persists for more than 2 weeks in the patients it turns into
chronic LBP and may require medication interventions or even surgeries (Lam, Galvin &
Curry, 2013). This article strongly recommends Tai Chi as the first line non-pharmacological
intervention for the treatment of chronic low back pain. The authors have also assessed the
effectiveness of Tai Chi in patients suffering from chronic LBP for more than six months. Tai
Chi sessions of 24 weeks have proven to be beneficial for the patients. The researchers
suggest the use of non-pharmacological treatment options as interventions since these cause
lesser harm than the pharmacological options. The treatment of Tai Chi should be
administered by proper providers who possess relevant training in the therapy. The
researchers did not find any adverse effects related with the tai Chi intervention.
In the article by Lawford et al. (2016) it has been implemented that walking can
effectively improve the status of disability, movement and functional ability in adults
suffering from chronic low back pain. This article has evaluated the effectiveness of walking
compared to other non-pharmacological treatments in the improvement of quality of life in
the adults with chronic back pain. Even though most of the evidences suggested that walking
is not more effective than the other complementary therapies, the authors have found one
article that considered it to be more beneficial.
Recommendations for Future Research
Research on the effectiveness of alternate therapies such as spinal manipulative
therapy, acupuncture and dry-needling is very limited. More elaborate research studies should
be conducted that will be helpful for future purposes of evaluation. Exercise therapies such as
Tai Chi can be used as non-pharmacological interventions to help manage LBP in adults
(Reiner, Tibi & Lipsitz, 2013).Evidence based researches should include a greater number of
population for studying the effects of the therapeutic techniques to ensure a relevant outcome

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that can be meta-analyzed (Goertz et al., 2013). The physical exercise therapies can be used
as complimentary approach to manage the pain in adults. Database searches conducted in the
review articles should use proper key terms and adhere to the interventions aimed at getting
more research findings. This will be helpful for evaluation of the effective measures that have
the capacity to effectively reduce the chronic LBP in adults. The studies should consist of low
risk of bias by adhering to a fixed sample size and relevant population. Inclusion of mixed
population of patients and irrelevant interventions can result in lack of homogeneous
information for conduction of future systematic reviews (Cherkin et al., 2016). The difference
of the outcomes in various patients should be elucidated more clearly to establish a well-
analyzed result and for providing a targeted strategy that can be useful for treating the
patients suffering from LBP.
Step 2: Annotated Bibliography
Yeganeh, M., Baradaran, H. R., Qorbani, M., Moradi, Y., & Dastgiri, S. (2017). The
effectiveness of acupuncture, acupressure and chiropractic interventions on treatment
of chronic nonspecific low back pain in Iran: A systematic review and meta-
analysis. Complementary therapies in clinical practice, 27, 11-18.
In this article the authors have focused on exploring the effectiveness of several
complementary therapies that can reduce the chronic lower-back pain (LBP) in adults as
compared to pharmacologic interventions. The major strengths of the study include its
strategy for conducting a broad search that ensured the authors to evaluate the current and
relevant studies for the systematic review. The quality of the methodology of the articles
considered was quite poor. The precision of the search findings were affected by the small

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sample sizes of the researches. The heterogeneity of the interventions, subjects, treatment
methods and outcomes hampered the conduction of the meta-analyses of the articles.
Lizarondo, L. (2016). Chronic Low Back Pain: Physical Therapy.
In this article the author has focused on the management of the chronic low back pain
through physiotherapy. The author has recommended multiple patient-specific, graded and
active exercises for the management of chronic low back pain (LBP). The choice and dosage
of each exercise should be clinically judged regarding the severity of LBP in individual
patients. Due to lack of evidence or presence of many arguable reports, the interventional
methods of ultrasound, low level laser therapy, TENS, superficial heat or cold therapies and
lumbar support could not be recommended by the authors.
Dias, M. (2018). Chronic Low Back Pain: Tai Chi.
This research article focuses on the fact that intervention of Tai Chi, a non-
pharmacological mind-body exercise therapy, can be effective in reducing chronic low back
pain (LBP) in adults. One of the many non-invasive treatment options available for treating
the chronic LBP includes Tai Chi. The researchers suggest the use of non-pharmacological
treatment options as interventions since these cause lesser harm than the pharmacological
options. The treatment of Tai Chi should be administered by proper providers who possess
relevant training in the therapy. The researchers did not find any adverse effects related with
the tai Chi intervention.

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References
Chaparro, L. E., Furlan, A. D., Deshpande, A., Mailis-Gagnon, A., Atlas, S., & Turk, D. C.
(2013). Opioids compared to placebo or other treatments for chronic low-back
pain. Cochrane Database Syst Rev, 8(8).
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R.
J., ... & Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive
behavioral therapy or usual care on back pain and functional limitations in adults with
chronic low back pain: a randomized clinical trial. Jama, 315(12), 1240-1249.
Eccleston, C., Fisher, E., Craig, L., Duggan, G. B., Rosser, B. A., & Keogh, E. (2014).
Psychological therapies (Internet-delivered) for the management of chronic pain in
adults. The Cochrane database of systematic reviews, 2.
Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J., ... &
Meeker, W. C. (2013). Adding chiropractic manipulative therapy to standard medical
care for patients with acute low back pain: results of a pragmatic randomized
comparative effectiveness study. Spine, 38(8), 627-634.
Holtzman, S., & Beggs, R. T. (2013). Yoga for chronic low back pain: a meta-analysis of
randomized controlled trials. Pain Research and Management, 18(5), 267-272.

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Lam, M., Galvin, R., & Curry, P. (2013). Effectiveness of acupuncture for nonspecific
chronic low back pain: a systematic review and meta-analysis. Spine, 38(24), 2124-
2138.
Licciardone, J. C., Minotti, D. E., Gatchel, R. J., Kearns, C. M., & Singh, K. P. (2013).
Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a
randomized controlled trial. The Annals of Family Medicine, 11(2), 122-129.
Lyons, K. J., Salsbury, S. A., Hondras, M. A., Jones, M. E., Andresen, A. A., & Goertz, C.
M. (2013). Perspectives of older adults on co-management of low back pain by
doctors of chiropractic and family medicine physicians: a focus group study. BMC
complementary and alternative medicine, 13(1), 225.
Mafi, J. N., McCarthy, E. P., Davis, R. B., & Landon, B. E. (2013). Worsening trends in the
management and treatment of back pain. JAMA internal medicine, 173(17), 1573-
1581.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The
Lancet, 389(10070), 736-747.
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for
acute, subacute, and chronic low back pain: a clinical practice guideline from the
American College of Physicians. Annals of internal medicine, 166(7), 514-530.
Reiner, K., Tibi, L., & Lipsitz, J. D. (2013). Do mindfulness-based interventions reduce pain
intensity? A critical review of the literature. Pain Medicine, 14(2), 230-242.