Back pain is a common complaint that frequently sends people to their doctors’ offices. Most of us will experience it as some point in our lives.
But as with another all-too-familiar malady, it can be hard to find relief. “Kind of like the common cold … we don’t yet have a cure for routine back pain,” says Dr. John Mafi, an assistant professor of medicine at the University of California–Los Angeles and scientist at RAND Corp., a nonprofit research organization. “So we end up throwing lots of services and technologies [at the problem] that don’t impact outcomes, and in fact drive up costs and sometimes can harm patients.”
About $86 billion is spent annually in the U.S. to treat back pain, he says. And potentially unnecessary health services that include the use of MRIs, CT scans, prescription opioid painkillers and referrals to specialists have increased by 50 to 100 percent over the past decade, says Mafi, who studied treatment of back pain from 1999 through the end of 2010. Evidence-based guidelines suggest taking more conservative measures to manage routine back pain, including using nonsteroidal anti-inflammatory drugs, or NSAIDs, and Tylenol as well as physical therapy. Taking a conservative approach also means reserving imaging for rarer cases when red flags emerge, such as possible neurological issues, leg pain in addition to back pain or trauma that may have caused a fracture in the spine.
Though there’s some signs opioid prescribing may now be leveling off amid concerns about opioid abuse and drug overdoses, the drugs are still widely used to treat all kinds of pain. There’s no evidence that taking opioids long-term is effective in treating chronic back pain, says Dr. Richard Deyo, a professor of family medicine and internal medicine at Oregon Health & Science University in Portland. Even for acute back pain lasting three months or less, research finds prescription pain drugs may not do any better to address the pain than over-the-counter anti-inflammatory medications.
In addition to medication, patients with back pain are sometimes treated with spinal injections of steroids to relieve pain and spinal fusion surgery, which aims to provide back pain relief by fusing vertebrae together to stabilize the spine. And some experts have raised concerns that these more aggressive therapies are used too frequently, while noting that many patients may benefit from more conservative approaches to treat back pain.
[See: 11 Ways to Cope With Back Pain.]
“It’s not entirely a ‘less is more’ story. I think different is more,” Deyo says. “Because at the same time that I think we’re overusing opioids, and probably overusing spinal fusion surgery and probably overusing spinal injections, we may well be underusing things that may have more to do with lifestyle and quality of life, like exercise therapy and mind-body interventions, like cognitive behavioral therapy or mindfulness mediation.” The evidence supporting these underused approaches is at least as strong, he says, as for other more traditional, medical approaches to treat back pain. While experts emphasize there are no magic bullets or miracle cures to treat chronic back pain, treatment guidelines note non-drug approaches ranging from exercise to massage therapy and yoga are moderately effective at reducing the chronic back pain.
“For low back pain, of all the treatments out there … the best treatment is exercise,” says Dr. Patrick Roth, chairman of the department of neurosurgery at Hackensack University Medical Center in Hackensack, New Jersey. He notes that red flags ranging from a fall that led to the pain (which could indicate a fracture) to significant pain in the legs should be discussed with a health professional before starting an exercise routine.
Notably, experts say, a small proportion of patients will benefit from aggressive treatment, like spinal fusion surgery. “Sometimes people just have gross instability in their back, and they really do need an operation to stabilize,” says Roth, who performs surgery to treat patients in such circumstances. “But for the most part, the vast majority of back pain should be treated through a program of exercise.” That includes focusing on muscles in the abs and back, doing core exercises like planks and squats, and practicing proper lifting technique, like squatting with an arched back. Of course, it’s no quick fix, he adds, a reason many patients are reluctant to do it. “[It takes] a sustained effort over a period of months,” Roth says. But all that effort can make a significance difference in relieving pain. “Doing exercises to stretch and strengthen that core region is going to go a long way to both preventing and treating low back pain,” Mafi says. He adds that it’s important to resist the urge to avoid all activity when back pain first sets in, which can lead to stiffness that only makes the pain worse. Instead, stay on the move with a gentle but active approach, such as walking, experts say, and doing core exercises as you’re able.
[See: 5 Physical Therapy Procedures You Should Question.]
Roth emphasizes the importance of maintaining autonomy by both learning about back pain and having confidence that you can personally overcome it. What may seem like a pep talk is a particularly poignant consideration given baked-in incentives to overtreat back pain, which can leave patients worse off. While surgery and injections are financially lucrative, experts say, there’s less monetary incentive for health providers to spend precious appointment time discussing lifestyle changes that could help. “Counseling about exercise and lifestyle and so forth are often not so well reimbursed by insurance,” Deyo says.
Nor is it a forgone conclusion you need to see your doctor about back pain. Where some people have chronic back pain — with no end in sight to that pain — most suffer from more acute pain, lasting weeks to a few months. “The vast majority of back pain gets better on its own,” Roth says, though he adds it’s also common to experience back pain again in the future.
“If you’re worried, it’s reasonable to go see the doctor,” Mafi says. However, he reiterates that often MRIs are ordered unnecessarily and cautions against patients going along for the ride. “I just saw a patient … with back pain, and talked her out of an unnecessary MRI,” he says. While certain issues that may arise in a physical exam — from concern about a fracture to possible cancer to neurological issues — warrant ordering an MRI, experts say often the imaging test is done when it’s not needed. The problem is that MRI is so sensitive that most tests will pick up abnormalities, and very frequently those have nothing to do with the back pain itself, Mafi says. He gives the example of imaging that finds wear-and-tear arthritis or a bulging disc. Though on its face that might seem like an obvious culprit for pain, often it may have nothing to do with the pain, and the image can start a wild goose chase that complicates matters, rather than providing clarity. “Then you’re forced down this cascade of unnecessary testing and treatment procedures that lead potentially to harm,” Mafi says.
[See: 5 Common Preventable Medical Errors.]
Roth adds that in most cases, the exact cause of back pain is never fully understood — no matter how much testing is done — and the focus should shift away from solving the medical mystery to taking common sense steps to reduce pain and improve quality of life. That may still involve taking medication — preferably starting with less potent varieties, like anti-inflammatory drugs — and other forms of treatment, like injections, for some patients. But Roth says medical treatment should be viewed as a supplement to what the individual does himself or herself to address the pain. “The vast majority of back pain is very much self-manageable,” Mafi says. Though for those who are in pain, experts add, there’s no getting around that reducing the discomfort takes work.
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How to Stay Off the Back Pain Treatment Carousel originally appeared on usnews.com
