Chronic back pain is a worldwide problem. A study by the World Health Organization found it to be the No. 1 cause of disability across the globe.

While a sedentary lifestyle — sitting at a desk all day and being a “couch potato” — contributes to the problem, so does a job that requires a lot of physical work. Back problems plague people who live in wealthy countries as well as those who live in third-world areas.

One of our textbooks from chiropractic school was titled “Managing Low Back Pain.” The lead author was Dr. William Kirkaldy-Willis, an orthopedist. He stated that he chose the title because for many patients, back pain is a chronic, recurring condition. In his view, the best approach is to focus on long-term steps to control it, rather than seeing it as a condition that can be treated once, expecting to cure the patient.

Many patients use medications to control chronic back pain, especially anti-inflammatory drugs like ibuprofen, aspirin and naproxen. It is estimated that 30 billion doses are consumed in the U.S. every year.

But these drugs have serious side effects. They are the second leading cause of ulcers, causing more than 100,000 hospitalizations and 17,000 deaths every year in the U.S. They also are associated with deaths due to heart disease. Tylenol is not a lot better, it is the leading cause of acute liver failure in the U.S. And we all know about the dangers of the newer opiate drugs like oxycodone and hydrocodone, with their tendency to cause addiction. Are there better, especially safer, options to control chronic back pain?

One study supports an old chiropractic idea, called maintenance care. For a long time, chiropractors have urged their patients to continue care on a preventive basis, to keep the gains they have made with their care, to prevent future spinal problems, and improve overall health. This study recruited 40 patients with chronic back pain that had lasted at least six months. They all got a month of chiropractic treatment, which significantly helped their pain. For half the patients, treatment was stopped there, and for the rest, they continued treatment every two weeks for nine more months. At the end of the trial, 10 months in all, the patients who followed through on the maintenance care not only kept the relief they gained from the first month of care, but they actually continued to improve. The other patients tended to lose most of the benefit over the next nine months.

Acupuncturists have their own versions of this. One approach is to see a patient at least four times a year, at the change of the seasons. I also use acupuncture as a method of pain control; most chronic pain patients benefit from supportive treatment between once a month and once every two or three months.

Herbal alternatives to anti-inflammatory drugs help control chronic pain. Willow bark has been used for centuries, and is the basis for aspirin. But while the natural herbal version may produce mild stomach upset, it does not cause life-threatening stomach ulcers or thinning of the blood like aspirin. Boswellia, turmeric and ginger are all used for chronic pain and inflammation, and are very safe.

But the most effective approach for any particular patient is whatever combination of the above works for them. Chronic back pain is usually a complicated problem that requires several treatment approaches, including lifestyle changes. We all differ in our responses to treatment — the art of pain control is to find the right mix of manipulation, acupuncture, or herbals that provides relief without harming the patient.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.