1. Chiropractic care
Koning says he refers many patients for chiropractic care. “There’s more to it than just ‘cracking and popping.'” Chiropractors can provide manual therapy, massage, stretching, and cervical or lumbar traction, which are helpful in alleviating muscle pain and improving range of motion and flexibility, he noted.
However, there are instances when chiropractic care should be avoided. This is “typically why I ask patients to consult with me before seeking chiropractic care,” Koning said. “I would not recommend this to patients with pain related to severe degenerative joint disease or spinal stenosis, for example.”
After chiropractic treatment, massage is the most sought after treatment for chronic neck and low back pain, according to Koning. “It’s a mainstay for me in treating most of my patients.” Specifically, he recommends “lighter” pressure types, such as Swedish massage, for those with hypersensitivity syndromes like fibromyalgia, and for some with chronic headaches or migraines.
“Alternatively, for patients with chronic low back and neck pain, deep tissue [massage] can be more helpful over the long haul,” Koning said. If a patient is developing a lot of areas of focal muscle spasm, then the “stronger” myofascial release and deep tissue massages will more effectively treat them, he noted. But if a patient “hurts all over” and is very sensitive to touch, deep tissue isn’t going to help and may in fact worsen their pain, according to Koning. “So I recommend ‘lighter’ massage types like Swedish.”
“I think acupuncture has a place in pain management, but it doesn’t work in all cases, and the research on its efficacy is very conflicting,” Koning said. Some studies suggest it’s most effective in alleviating chronic neck pain and headaches. “I’ve found [this] anecdotally to be true, and will encourage patients with those problems to try it.” Also, it can be effective in improving low back pain, and one study recently even suggested its use in uncontrolled pain related to menstrual cramps, he noted.
“In all, acupuncture usually isn’t my first or second choice in alternative treatment options for patients.” Doctors are not sure quite how or if acupuncture works, he added. “We assume it works somehow by stimulating the body’s natural healing and anti-inflammatory reactions.”
4. Low-impact exercise
“Fibromyalgia is one of these chronic pain conditions in which the literature has suggested, recently, that plain old consistent low-impact exercise — such as walking, swimming, and cycling — is just as effective in reducing pain levels and increasing functionality as is taking opioids or anti-depressants,” Koning said. “In fact, in the case of fibromyalgia, taking opioids on a long term basis can actually worsen the progression of the disease over time, thus increasing instead of decreasing pain levels.”
5. Yoga, Tai Chi, and Pilates
Yoga, tai chi, and Pilates have all been shown to be effective in improving pain scores and reducing stress, according to Koning. “I recommend this to most of my patients with chronic neck and low back pain, as well as chronic joint pain.”
Most studies will at least say that these practices are “not inferior” to other prescription medications, he noted. All of these practices involve slow, controlled body movements, which can over time strengthen muscles, shed weight, and improve balance in a way that reduces pain. “They also encourage mindfulness and meditation that can help switch one’s mind off of constantly thinking about pain,” Koning said.