National Center for Complementary and Integrative Health (NCCIH)

NIH…Turning Discovery Into Health

Follow NCCIH Subscribe to our email update Subscribe to the NCCIH RSS feed Follow NCCIH on FacebookRead our disclaimer about external links Follow NCCIH on TwitterRead our disclaimer about external links

Menu
N C C A M Research Blog

New Standards Being Developed for Studying Low-back Pain

May 17, 2013
Dr. Partap Khalsa
Partap Khalsa, D.C., Ph.D.

Program Director
National Center for Complementary and Alternative Medicine

View Dr. Khalsa's biographical sketch

A woman holds her back in pain.As we know, chronic low back pain (cLBP) is an enormous public-health problem—and a frustrating one to patients, health-care providers, and researchers. Up to one-quarter of Americans experience LBP per year, and for some, that pain becomes chronic—a condition that costs the United States an estimated $100 billion per year. Current best practices for its diagnosis and treatment are only partially successful.

In March 2013, the Annals of Family Medicine published findings from an NCCAM-supported study on osteopathic manual treatment (OMT), compared with ultrasound, as a short term complementary treatment for cLBP. This study found that there was a modest but statistically significant improvement in reported pain, though not in function, among study participants receiving OMT. The good news is that this study adds to the growing body of evidence suggesting that spinal manipulation and other non-pharmacological interventions can be at least somewhat helpful for some patients with cLBP.

The bad news is that it is difficult to put this and many other studies on cLBP into a larger perspective because researchers often use inconsistent terminology, case definitions, baseline assessments and outcome measures. As a result, it can be challenging to compare studies of various interventions, replicate findings, pool data from multiple studies, resolve conflicting conclusions, and/or develop consensus regarding interpretation of findings.

Addressing the challenge of comparing data across different studies is the charge of the Task Force on Research Standards for Chronic Low Back Pain. The Task Force, which is a working group of the NIH Pain Consortium, was formed following two NIH workshops in 2009 and 2010 on research challenges and needs related to back pain. A key outcome of these workshops has been the call for common standards, measures, and other tools to be used in future clinical research on cLBP. Examples of needed standardized data include a common definition of cLBP, study-eligibility criteria, minimal dataset of assessments, and measures of cLBP outcomes.

So far, the Task Force has held three meetings since 2012. Members have been reviewing existing evidence, discussing those findings and proposed concepts, and drafting elements and language. Helpful pre-existing examples and processes have been the NINDS Common Data Elements project and the Research Diagnostic Criteria process. The next steps will be to create a formal written draft of the standards, obtain feedback from key stakeholders, and publish/disseminate the standards.

I am very enthusiastic about this endeavor and thank the impressive cadre of experts serving on the task force. I believe that we can all look forward to the “boost” these new standards will give research on cLBP and the eventual impact on clinical practice.

Comments

Comments are now closed for this post.

Thanks for your efforts toward standardizing our language!This offers us an excellent opportunity to collaboriate across disciplines and make our work truly comprehensive.

This is a great idea and plan. I, too, am frustrated by research that seems contradictory but in fact uses different baseline assessments, different outcome assessments, and different treatments under the same approach. The use of manipulation is a perfect example. Sometimes it is chiropractic, sometimes PT provided, and sometimes osteopathic. As most of us know, all of those manipulations are slightly different and thus can produce different results. Thanks again Dr. Khalsa!

Good news — and I fervently hope the task force is considering the inclusion of the ancillary factors in the treatment that might be effective or ineffective.  For example does a protocol using HVLA alone have different outcomes than the additional use of ultrasound, nutritional counselling, prescribed exercises or deep tissue therapeutic massage?  I appreciate the difficulty of designing such studies, but since these are the options many practitioners use every day, we must judge which are effective and cost effective.

A big task but badly needed. Good Luck.

This is a great idea and plan. I, too, am frustrated by research that seems contradictory but in fact uses different baseline assessments, different outcome assessments, and different treatments under the same approach. The use of manipulation is a perfect example. Sometimes it is chiropractic, sometimes PT provided, and sometimes osteopathic. As most of us know, all of those manipulations are slightly different and thus can produce different results. Thanks again Dr. Khalsa!

[commercial link removed, per policy]

A great undertaking, long overdue and a monumental task. I could not find any chiropractors listed on the Task Force membership. Would it not be prudent to include at least one D.C. in this group? There are more than 60,000 chiropractors in the U.S. treating 100 or more cases of back pain weekly. It is my belief that representation from this group would be valuable to the project.

 There are many causes of lower back pain in women and men and thusmany ways of treating it. This effort will go a long way in standardizing language across the board so that treatments can be properly tracked so more patients can get the best quality care.  

[commercial link removed, per policy]

Dr. Malay, please answer my question posted July 25. 2013. There is a rather large group of professionals treating back pain daily with high quality care and excellent results. How is it that this group is not represented on the Task Force?

There is a common denominator to the vast majority of back pain. It is inflamation and joint dysfuntion due to disc degeneration. The key to reducing the effects of disc degeneration is to follow a program designed to reduce and in some cases reverse the effects of that degenerative process. Drugs such as steroids are a good crutch, but little more than a crutch that is sometimes useful to get “ahead of the pain”. Those who follow a small effort daily to maintain disc integrity most often can enjoy life with few interruptions of back pain disability. A systematic approach is the best. From 30 years of practice, I can say with the greatest degree of certainty that those patients who do a little regular maintenance, get the best results. Discs need to be decompressed along with reducing inflamation.

Good articleThere is a common denominator to the vast majority of back pain. It is inflamation and joint dysfuntion due to disc and vertebre misalignment as well. 

[commercial link removed, per policy]

I have been living with back pain for so long now. I have found numerous ways to reduce my pain and even make it go away completely. I do yoga and stretch every day, I exercise and eat healthy, and now I even use an inversion table. It has helped with my back pain and this review site …. reviews some good tables you might want to consider. Thanks for the great article. Really insightful!

[commercial link removed, per policy]

Dr. Khalsa,Thank you for your contributions towards low back pain comprehension. I am living proof that chronic lower back pain including sciatica systems can be reduced and eliminated. I suffered from L4-5 damage. A diskogram revealed I had a hole in my disk and tested for 18psi. Spine surgery was recommended by top spine specialist in both Northern and Southern Calif. As a last resort for relief, with nothing to lose. I developed a self-spine decompression method. My pain/injury began in July 2008. I am know fully functional with out prescriptions for pain. Please contact me, I am on a quest to end chronic back pain for most and minimize syptoms for all. I realize you may think I may be in error. I promise you, I will get the method out via social media, crowd funding and eventually in medical journals. My youtube channel “how to” video is in the works and I will soon be publishing my method. The beauty of my method, is that it can be performed through out the day at home or work. It takes 1-2 seconds and gives instant relief as necessary.Our intelligent design makes it possible to self-spine decompress on que. Please reply, I seek to prove to you that self-spine decompression method is the disruptive solution to reducing the cost of 100 Billion per year.Save your back, save your life.ddotdan

Having read samples of the literature and all of the comments here, one must be forced to conclude that effective descriptors must be developed and adhered to.  Garbage can descriptors such as acute, chronic and mechanical back pain are symptoms, not diagnoses.A better job can be done by requiring physicians and body workers to use agreed upon objective findings and functional limitations associated with a diagnosis.  I wish you well on redirecting the energy of the “low back pain” community.

Thanks for your comments.  Dr. Khalsa worked with the NIH Pain Consortium to post the task force's charge, roster, and past meeting agenda's on their website.  http://painconsortium.nih.gov/

 

I have been living with back pain for so long now. I have found numerous ways to reduce my pain and even make it go away completely. I do yoga and stretch every day, I exercise and eat healthy, and now I even use an inversion table. It has helped with my back pain and this review site …. reviews some good tables you might want to consider. Thanks for the great article. Really insightful! 

[commercial link removed, per policy]

Hello Art Walker, CC Dr. Khalsa, NCCAM, NIHMy last comment was on Nov 12, 2013. Since then, I have followed up.Below is a video demo which shows New Intelligent Design method to self spine decompress.In short, the Latissimus Dorsi gets stretched, then the Lumbar fascia gets released/relaxed (flexible), which allows the Lumbar Disc to decompress, then enables the Lumbar Vertebrae to realign back to it’s natural position. Consistant practice and confidence enables me to maintain flexibility and mobility in my Thoracolumbar Fascia. All in 2 seconds! As necessary to keep inflammation to Zero during labor man hours.I am 100% pain free..I saved my back..Isaved my life!Please invite me to the next2-4-2014 IPRCC Meeting.The Battle VS low back pain has been WON! If NCCAM/NIH really wants to win the WAR, you’ll need the Intelligent Design Method, I uncovered in 2008. This method is the “GAMECHANGER”. It allows the individual to become their own “ON-CALL THERAPIST” 24/7.More important, the method is performed on cue with out any devices, medications, beverages, assistants, etc. Enabling individual to prevent any inflammation from developing in the low lumbar spine.I am trying contact communication with Robert Schleip PhD and emailed Professor Helene Langevin at University of Vermont. Two leading researchers of FASCIA & low back pain. Please contact me. Take a look at the crowdfunding campaign I have submitted and currently promoting. Abolish chronic Low Back Pain for 1 Billion People… [….]integrity towards progress,ddotdanThank you Pres. Obama, for pushing me to “do the improbable” 

[commercial link removed, per policy]

Stressless chairs have been approved by the American Chiropractic Association - might be a viable option

[commercial link removed, per policy]

Having a back pain is such a problem worldwide and it is daunting given the field of medicine is flourishing, how there is not much effective back pain treatment available today. So this study is very interesting, thanks for sharing it with us.

[commercial link removed, per policy]