Q. I have chronic back pain and have not found relief through conventional treatment. I’m considering manual therapy. Is this treatment generally worthwhile?

A. Manual therapy of bones and muscle (osteopathy) can be beneficial for some people. The main types are osteopathic manipulation, chiropractic therapy, physical therapy, and massage. Doctors of osteopathy have the initials D.O. after their name. (They have attended a medical school similar to those attended by M.D.s.) Research has shown osteopathic manipulations to be effective and safe.

Chiropractors use various types of spinal manipulation to treat muscle and joint pain. They are not licensed to practice medicine and may not prescribe medication. The National Association for Chiropractic Medicine is their professional association. If you decide to see a chiropractor, ask whether he or she belongs to this organization. Though it’s no guarantee, membership in the association suggests that the individual is reputable.

Physical therapists can apply manual therapy to your joints or recommend exercises to relieve back pain.

Massage therapy is widely available; however, little is known about the effects of massage therapy on back pain.

Some therapies may not be covered by insurance; don’t take more sessions than you think you need. And if it hurts, don’t continue the treatment.