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Dietary Supplements for Back Pain

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NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

Dietary supplements are a topic of great public interest. Whether you are in a store, using the Internet, or talking to people you know, you may hear about supplements and claims of health benefits. How do you find out whether "what's in the bottle" is safe to take and whether science has proven that the product does what it claims? This fact sheet provides some answers.

What are dietary supplements?
Dietary supplements (also called nutritional supplements, or supplements for short) were defined in a law passed by Congress in 1994.1,2

Dietary Supplements:

  • Are taken by mouth.
  • Contain a "dietary ingredient" intended to supplement the diet. Examples of dietary ingredients include vitamins, minerals, herbs* (as single herbs or mixtures), other botanicals, amino acids, and dietary substances, such as enzymes and glandulars.
  • Come in different forms, such as tablets, capsules, softgels, gelcaps, liquids, and powders.
  • Are not represented for use as a conventional food or as a sole item of a meal or the diet.
  • Are labeled as being a dietary supplement.

Dietary supplements are sold in grocery, health food, drug, and discount stores, as well as through mail-order catalogs, TV programs, the Internet, and direct sales.

Is using supplements considered conventional medicine or complementary and alternative medicine (CAM)?
Conventional medicine is medicine as practiced by holders of MD (medical doctor) or DO (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians.

Some uses of dietary supplements have become part of conventional medicine. For example, scientists have found that the vitamin folic acid prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the eye disease age-related macular degeneration.

On the other hand, some supplements are considered complementary and alternative medicine (CAM), either the supplement itself or one or more of its uses. An example of a CAM supplement would be an herbal formula that claims to relieve arthritis pain, but has not been proven to do so through scientific studies. An example of a CAM use of a supplement would be taking 1,000 milligrams of vitamin C per day to prevent or treat a cold, as the use of large amounts of vitamin C for these purposes has not been proven.

Health care practices and products that are not presently considered to be part of conventional medicine are called CAM. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. There is scientific evidence for the effectiveness of some CAM treatments. But for most, there are key questions yet to be answered through well-designed scientific studies, such as whether they are safe and work for the diseases or conditions for which they are used. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), is the Federal Government's lead agency for scientific research on CAM.

How can I get science-based information on a supplement?
There are several ways to get information on supplements that is based on the results of rigorous scientific testing, rather than on testimonials and other unscientific information.

  • Ask your health care provider. Even if your provider does not happen to know about a particular supplement, he or she may access the latest medical guidance about its uses and risks.
  • Dietitians and pharmacists also have helpful information.
  • You can find out yourself whether there are any scientific research findings on the CAM supplement you are interested in.

If I am interested in using a supplement as CAM, how can I do so most safely?
It is important to talk to your health care provider (or providers, if you have more than one) about the supplement. This is for your safety and a complete treatment plan. It is especially important to talk to your provider if you:

  • Are thinking about replacing your regular medical care with one or more supplements.
  • Are taking any medications (whether prescription or over-the-counter). Some supplements have been found to interact with medications (see below).
  • Have a chronic medical condition.
  • Are planning to have surgery. Certain supplements may increase the risk of bleeding or affect anesthetics and painkillers.
  • Are pregnant or nursing a baby.
  • Are thinking about giving a child a supplement. Many products being marketed for children have not been tested for their safety and effectiveness in children.3
  • Do not take a higher dose of a supplement than what is listed on the label, unless your health care provider advises you to do so.

If you experience any side effects that concern you, stop taking the supplement, and contact your provider. You can also report your experience to the U.S. Food and Drug Administration's (FDA) MedWatch program, which tracks consumer safety reports on supplements (1-888-463-6332, Website: www.fda.gov/medwatch/report/consumer/consumer.htm)). If you are considering or using herbal supplements, there are some special safety issues to consider. See the NCCAM fact sheet Herbal Supplements: Consider Safety, Too; For current information from the Federal Government on the safety of particular supplements, check the "Alerts and Advisories" section of the NCCAM Web site or the FDA Web site.

Supplements and Drugs Can Interact
For example:

  • St. John's wort can increase the effects of prescription drugs used to treat depression. It can also interfere with drugs used to treat HIV infection, to treat cancer, for birth control, or to prevent the body from rejecting transplanted organs.
  • Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs.
  • Ginkgo, taken with anticoagulant or antiplatelet drugs, can increase the risk of bleeding. It is also possible that ginkgo might interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels.4

National Center for Complementary and Alternative Medicine (NCCAM)
National Institutes of Health
Bethesda, Maryland 20892 USA
Web: nccam.nih.gov
E-mail: info@nccam.nih.gov

NCCAM Publication No. D191
September 2003
Reviewed July 2004

Updated on: 06/01/10
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