Traditional Medicine in the Treatment and Reduction of Back Pain: A Systematic Review

Abstract

Context: Back pain is recognized as a major contributor to healthcare costs and disability worldwide. In addition to medical interventions, complementary and alternative medicine may offer satisfying options for managing back pain. Objectives: The present study aimed to review available evidence regarding traditional medicine methods to ameliorate chronic back pain. Methods: A systematic search was conducted in Web of Science, Scopus, ProQuest, PubMed, and Iranian databases such as Rondo, Magiran, and SID up to February 2023 using related keywords. Controlled trials involving traditional medicine interventions for chronic low back pain (CLBP) were sought to evaluate clinical effectiveness. Additionally, the Cochrane Collaboration’s tool was applied to assess the risk of bias in selected studies. Results: From 628 published studies, eight randomized controlled trials (RCTs, n = 729) were included in this systematic review, investigating complementary and alternative therapies (CATs) for CLBP. Interventions included Tai Chi, acupuncture (hand-ear, electronic), massage-based therapies (Fateh method, Thai self-massage, Tuina), Gua Sha, and comfrey root ointment. All studies reported statistically significant improvements in pain and/or function. Tai Chi and acupuncture demonstrated moderate-to-large effect sizes, while comfrey ointment and Gua Sha yielded rapid symptom relief. The risk of bias was low to moderate, with limitations primarily in blinding and allocation concealment. Several studies lacked comprehensive reporting of effect sizes and confidence intervals, limiting quantitative synthesis. Conclusions: The CATs demonstrated clinically meaningful benefits in reducing pain and improving function in individuals with CLBP. Despite variability in methodological rigor and geographic concentration of studies, these interventions hold promise as effective non-pharmacologic options. Future research should emphasize larger trials, consistent outcome reporting, and long-term follow-up to better establish their role in CLBP management.