In this second installment of a four-part series on back pain, find out where to turn to beat back the pain.
By Richard Trubo
Reviewed By Brunilda Nazario
Every year, millions of men and women find themselves aching for a way to put their back pain on the back burner. Perhaps they've slipped and tumbled down a flight of stairs, severely straining their back in the fall. Or they've picked up a heavy object and paid the price with sharp and shooting back pain and have been cringing ever since.
Up to 80% of people will have low back pain at some point in their lives, according to the American Academy of Orthopaedic Surgeons. In fact, back pain is the leading cause of disability in people aged 19 to 45.
In a recent public survey conducted by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) -- the medical organization representing physiatrists (medical doctors specializing in physical medicine and rehabilitation) -- one out of two respondents complained that they presently had low back pain, and in about half of those surveyed, the pain was severe enough to interfere with their daily activities, at times becoming debilitating.
Chiropractor Jerome F. McAndrews, DC, national spokesman for the American Chiropractic Association in Arlington, Va., recalls that his very first patient was a 6-foot-6-inch truck driver "who crawled into my front office door on his hands and knees crying. His back pain simply took all his strength away."
Back to Basics
Of course, the mere thought of going to a physician for low back pain sends a shiver down the spine of many people. They may be convinced that a visit to a medical doctor will put them on the fast track to the operating room. If that's the way you think, you can breathe a little easier. "The vast majority of people with back pain aren't candidates for surgery," says Scott D. Boden, MD, professor of orthopaedic surgery at Emory University School of Medicine and director of the Emory Orthopaedics & Spine Center.
"With back pain," explains Boden, "most episodes are self-limited, meaning that they get better no matter what you do. So generally there's not a lot of harm in waiting a bit before deciding to see a doctor."
Prior to ever making that doctor's appointment for back pain, you can try some conservative measures at home. "Stop the activities that might be aggravating the pain," advises Michele Zembo, MD, MBA, associate professor of orthopaedics at Louisiana State University Health Sciences Center in New Orleans. "Also try taking an over-the-counter medication such as aspirin, Tylenol, or ibuprofen."
You can also apply heat or cold to the painful area. Back specialists typically recommend:
- Applying ice packs for the first 48 to 72 hours after the back pain begins (this will decrease inflammation)
- Then switch to applications of heat, typically by using hot, moist towels
If the back pain isn't getting better after three or four days, then you might consider contacting your doctor, says Zembo.
When Waiting Isn't Smart?
Although a period of "watchful waiting" makes sense for most cases of low back pain, there are times when your predicament is more urgent and you shouldn't turn your back on calling your doctor. Sometimes, says Boden, back pain can be a symptom of a serious problem such as a spinal infection or a tumor. "If your back pain is associated with fever, chills, or night sweats, or undesired weight loss, see a doctor," he advises.
According to Zembo, "If you have numbness or tingling sensations in your legs or arms, or pain radiating down your leg, these are signs that you should see a doctor." Other back-related symptoms that could indicate a serious problem include:
- Weakness in the legs
- A new loss of bowel and bladder control
- Back pain that gets worse with the passage of time
- Back pain in a person with a history of cancer
- Back pain that is severe at night (most people with back pain feel some pain relief when they're lying down)
"Back pain associated with loss of bowel and bladder is very rare, but it's a neurosurgical emergency," says Lawrence W. Frank, MD, assistant professor in the department of physical medicine and rehabilitation and the department of neurological surgery at Rush Medical College in Chicago. But Frank stresses that only a very small minority of people with low back pain are candidates for surgery.
Conquering the Back Pain Blues
Your primary care doctor, family physician, or internist is a good place to start when you're seeking to get your back on track. She'll take a comprehensive medical history and conduct a full physical examination, checking your form when you walk, range of motion, mobility, and posture. She may order back X-rays, prescribe pain medication, and provide some education about your back as well, keeping in mind that low back pain often gets better on its own. "Very few treatments are actually proven to change the natural history, meaning the rate at which the patient would otherwise recover," says Boden.
During that initial office visit, your doctor might order some laboratory tests if she's concerned that a serious problem (such as a malignancy or an infection) might be causing your low back pain. She's also likely to tell you that complete inactivity is an enemy of recovery, and that when it comes to back pain, moderate exercise is better than no exercise at all. She might write a prescription for physical therapy and a personalized exercise program. According to Frank, this program may include stretching and strengthening of the muscles, and exercises designed to take mechanical pressure off the injured joints and discs.
Particularly if there's no progress after about a month of physical therapy, your primary care doctor may make a referral to a specialist who can order further tests and recommend additional treatment. These referrals may be to a medical doctor such as a:
More people than ever are also looking to alternative practitioners for back care, including chiropractors, massage therapists, or acupuncturists. In fact, in the AAPM&R survey, the most commonly consulted health care practitioners for back pain were not medical doctors, but rather chiropractors, physical therapists, and massage therapists.
Although chiropractors were once considered to be on the fringes of the health care system, that has changed dramatically, particularly since the mid-1990s. That's when the Agency for Health Care Policy and Research issued guidelines concluding that spinal manipulation -- the foundation of chiropractic treatment -- is a "recommendable method of symptom control" and "can be helpful for patients with acute low back problems without radiculopathy (nerve irritation caused by disc damage) when used within the first month of symptoms." With the increased interest in chiropractic, about 30 million people in the U.S. were treated by chiropractors in 2003, according to McAndrews.
Another type of practitioner could be an important component of your back-related health care team -- namely, a mental health professional. In a study published in the journal Pain in January 2004, researchers at the University of Alberta, Canada, found that depression is a risk factor for back pain. If you're depressed, you have a greater likelihood of developing back pain -- and vice versa -- and thus by effectively dealing with your depression, you could put a positive twist on your back pain.
Published July 19, 2004.
SOURCES: Scott D. Boden, MD, professor, orthopedic surgery, Emory University School of Medicine, director, Emory Orthopaedics & Spine Center, Atlanta. Lawrence W. Frank, MD, assistant professor, physical medicine, rehabilitation and neurological surgery, Rush Medical College, Chicago; and Institute of Neurosurgery and Neuroresearch, Chicago. Jerome F. McAndrews, DC, national spokesman, American Chiropractic Association, Arlington, Va. Michele Zembo, MD, MBA, associate professor, orthopaedics, Louisiana State University Health Sciences Center, New Orleans.
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