Healthnotes Newswire (June 28, 2001)—There are many potentially effective treatments for low lack pain. A new review of double-blind trials, published in this week’s British medical journal BMJ, offers strong evidence that a combination of different approaches may work best.¹ Compared with single treatment approaches, combinations of psychological and physical treatments were found more effective at reducing pain and restoring function.

Psychological approaches in the clinical trials included counseling, education, relaxation exercises, recreational activities, posture training, biofeedback, and coping strategies for pain. Physical approaches included aerobic exercise, electrical nerve stimulation therapies, application of hot and cold packs, stretching, weight training, water exercises, and various home exercise programs.

The interdisciplinary rehabilitation programs were only found to be effective when they were intensive (i.e., more than 100 hours of therapy). Less intensive programs did not show the same improvements in symptoms. It remains unclear whether the improvements are worth the cost of these intensive treatments. However, the costs of low back pain in human and financial terms are staggering. In 1990, direct medical costs for low back pain exceeded $24 billion. Total annual costs for back pain exceed $56 billion when disability costs are included.^{2 3 4}