Complementary and Alternative Medicine in Back Pain Utilization Report Evidence Report/Technology Assessment Number 177

The high prevalence rates for neck, thoracic, and low back pain, indicate the importance of this health problem as a public health concern. Back related pain has a high morbidity and cost burden in the United States (U.S.) and other industrialized countries. Treatment for this pain can be multidimensional and include conventional care, complementary and alternative medicines (CAM), or both. CAM is comprised of a group of therapies that are considered to be outside the scope of treatment of most conventional practitioners or therapies. The large constellation of treatment modalities that constitute CAM are used widely throughout the U.S. and internationally, both by individuals who are healthy and those who have specific health concerns such as back pain. Use of CAM therapies can include visits to specific practitioners, as well as self-treatment (for example, when using herbal products, or relaxation techniques). Scope and Purposes of this systematic review: What CAM therapies are being used for treatment of persons with back pain in the United States? (overarching question) 1) What is the relative utilization for the different CAM therapies? i. Does the utilization differ by where the back pain is anatomically located (i.e., neck, mid-back, low back)? ii. Which therapies are used as complementary to conventional care and which are used as alternative? iii. When more than one therapy is used for back pain, how are these combined? 2) What is the utilization that is recommended by different types of healthcare providers? i. How do these recommendations compare to the actual utilization reported in studies from question one? ii. How do the recommended and actual utilization reported differ by CAM practitioner type? 3) What are usual costs for these therapies per treatment and for the prescribed course of treatments? i. How much of this cost is covered by insurance or included in health plans?