This article on Yahoo News caught my eye today. Americans are spending $86 billion a year for lower back pain treatment, but research finds little evidence that the population got better as spending soared over the last decade.
There is an attitude that, with all the fancy, high tech gizmos like digital x-rays and robotic assisted surgical machines that something invasive can and must be done to treat lower back pain. The reality is that time is often the best antidote. However, this advice does not sit will with most people with back pain. People are accustomed to seeking out immediate cures to their maladies and have a certain fear if something is not “being done.”
The biggest problem: When it comes to back pain, there’s no one-size-fits-most treatment. What may work for one case of back pain may make another case worse, depending on the source of the pain.
“There are a lot of procedures going on for patients in whom we don’t have good evidence that it’s going to help,” said Dr. Richard Deyo of Oregon Health and Science University in Portland, who long has studied how people fare with different options for this tough ailment.
The article goes on to say that exercise rehabilitation, where patients push past the pain, shows encouraging results. Surgery tends to have a low success rate, because with each successive surgery scar tissue and weakened structures are created potentially resulting in further weakness, loss of stability and mobility, and more pain.
One thing the article failed to mention was chiropractic treatment. Chiropractic has certain advantages over surgery and pain injections in that it is less invasive and destructive. When combined with exercise rehabilitation, chiropractic is a very good choice for most cases of lower back pain. However, it is a procedure and should be recommended only when the condition warrants it. Cases of severe disc herniation, for example, would not benefit from chiropractic in the acute stage, but may benefit in the post acute stage.
Here is the closing summary of the article:
What’s the best advice? First, some types of back pain are accompanied by red flags that need immediate attention — such as numb or weak legs or urinary problems. But for most people:
_Don’t expect an X-ray, MRI or CT until a month to six weeks has passed, unless the doctor suspects a more serious problem. Following that guideline is becoming a quality-of-care measure in many organizations.
_Get back to normal activity as quickly as possible; the days of prescribed bed rest are over.
_Patients with sciatica, pain radiating down the leg, have the best outcomes from those nerve-easing decompression surgeries, Deyo stressed. California’s Rosen said three criteria determine chances of success: a scan that correlates with the pain site; the patient has some weakness; and specific pain occurs when the doctor raises and straightens the legs.
Herniated disks heal on their own over about two years, but surgery for a faster fix is reasonable in good candidates, he said.
_Fusions are appropriate for far fewer patients, those with fractures, unstable or slipping spines, curvature of the spine and rare other reasons, Rosen said.
_Deyo recently studied surgeries for stenosis, that painful narrowing, and found decompression surgery as effective and less risky than fusions, which are more complicated and costly.
_A formal exercise program is especially effective if coupled with cognitive behavioral therapy that teaches patients to manage and function with pain, Deyo said.
_What if surgery fails? Usually, it was the wrong operation or the wrong candidate, said Rosen, who sees one or two patients a week classified as having “failed back syndrome” because of multiple failed surgeries.
Always get a second opinion. Rosen, who founded the Association for Medical Ethics, also recommends asking about a doctor’s ties to companies that make spine-surgery products. That way you’ll feel assured that a recommendation to cut doesn’t come from a too-cozy relationship.
_Not a good candidate? A primary care physician can be a neutral adviser in helping navigate next steps. Patients with more challenging back problems may fare better at a multidisciplinary spine center with numerous specialists — in rehab and pain management — under one roof.
Dan Perez, DC
(415) 627-9077
