Besides treatment provided by a doctor and self-care steps taken at home, some people have turned to chiropractic care and acupuncture for relief of back pain.

Chiropractic medicine is perhaps the most commonly used alternative therapy in the United States. It's based on the belief that certain illnesses and conditions result from impairment of your nervous system, due to problems with your joints.

To relieve mild to moderate back pain and reduce or eliminate the negative effects on your nerves, chiropractors manipulate and massage your spine and back muscles. Spinal manipulation can effectively treat uncomplicated back pain, especially if you've had the pain for less than 4 weeks.

A 1992 policy statement from the American Medical Association permits physicians to work with chiropractors — if physicians believe that chiropractic treatment offers a clear benefit. Although chiropractors use many standard medical procedures, they can't prescribe drugs or perform surgery.

People other than chiropractors also do spinal manipulation. Osteopathic doctors and physical therapists are trained in this treatment. And there's no evidence that chiropractors do better spinal manipulation than other health care providers.

If you're thinking of seeing a chiropractor, keep the following points in mind:

• First see the physician who provides your primary medical treatment. If you want spinal manipulation, ask your physician if it's appropriate. Manipulation of your spine can aggravate a disk problem or promote compression fractures if you have osteoporosis.

• If you seek chiropractic care without a referral, do so carefully. Find someone who attended a school accredited by the Council on Chiropractic Education.

• See only chiropractors who are willing to report to your physician, review recent X-ray films provided by your physician, give you a written treatment plan and allow your physician to observe chiropractic treatments.

• Avoid chiropractors who view spinal manipulation as a treatment or cure for a wide range of diseases. There's no evidence to support this idea.

An acupuncturist inserts hair-thin needles under your skin, causing little or no pain. The needles usually stay in for 15 to 30 minutes, and you may need several sessions. Research suggests that pain relief may come from the release of endorphins, your body's natural painkillers.

Although noting a lack of rigorously controlled research about the benefits of acupuncture, the National Institutes of Health concluded in 1998 that acupuncture may help conditions that involve chronic pain, including low back pain. The Mayo Pain Clinic has used acupuncture since 1974 in some cases in which people don't experience pain relief from medications or nerve blocks.

To find a qualified practitioner, ask for a referral from your physician or contact the American Academy of Medical Acupuncture (AAMA). Visit the AAMA Web site or call 323-937-5514. AAMA's members are licensed physicians with more than 200 hours of special training in acupuncture.