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Ten Ways to Manage Back Pain:
I am a joint replacement surgeon. In the operating room, in a given year I perform over 300 procedures related to joints, arthritis, and injury. In my office, half the patients I see have hip and knee arthritis; the rest have every other joint involved. The most difficult for many physicians to manage is back pain. I know that I am not alone in this.
Back pain has many sources. In general, there are so many experts out there concerning back pain that I am now wholly convinced that no one knows what the heck they are talking about in this entire specialty. One day surgery is good, the next it's bad. The alternative medicine people will extol the virtues of acupuncture to nutrition. Sometimes it works and sometimes it does not. There are more pillows and beds and commercial crap you can buy than there is room in the entire state of Rhode Island.
How can a reasonable person try to help themselves with back pain when the medical specialties are in such disagreement?
Here are a few things that may help you:
- Be your own best doctor. We often are more discriminating when buying a car than when seeking medical advice. After some period of time, you will know which mix of interventions help more than others. I am often amazed when a patient comes to me and says that they have back pain and have been in physical therapy for 3 years and it does not help. What exactly were they thinking after the first year?
- Understand the source of your pain. Some people have back pain from a degenerative condition, like arthritis. The joints in the back of the spine can wear and cause pain. Other sources of pain can be from a sudden injury or muscle strain. Sometimes the pain is due to a nerve being irritated by some disc material in the spine. There are even many valid theories that stress causes back pain. If you try to get a handle on the origin of the pain then this is a good place to start.
- See the right doctor. There are many physicians out there -- family medicine, internal medicine, rheumatologist, orthopaedic surgeon, neurosurgeon, chiropractor, and others -- that have a keen interest in back pain. There are may more from each of these specialties that don’t care as much about back pain. Choose a physician who has back pain high on their list of diseases they want to treat.
- Do not listen to lawyers. Many patient hurt their back on the job, in a motor vehicle accident, or in a slip and fall. The lawyer you choose may send you to a group of doctors who do every test under the sun and a series of bogus treatments not designed to make you better but to build your legal case. The only time a lawyer refers a case to me is when the first doctor, who was probably in their pocket, messed up the case so much, they actually need a real doctor to bail them out. While it is possible that the doctor your lawyer sends you to is good, ask around; you will probably find otherwise.
- Understand that there will probably not be one single treatment method that will work on its own. I have generally seen that combinations of drugs, rest, exercise, physical therapy, chiropractic, acupuncture, and more are needed in many situations. While it is important to try a number of these modalities, set a time limit on each of them. If there is no improvement within the first two months from a specific modality, the chances of it helping in the long run are low.
- Choose your physician or other health professional carefully, then listen to their advice. I can't tell how many patients want their back pain to go away but when I recommend something the patient says that they do not want to do that. For example, I may recommend taking ibuprofen. I will then get the response, "I don't take drugs." Then I may recommend epidural steroids and I hear, "I don't want any injection." Then I send the patient to a chiropractor and I hear, "I don't believe in that." The list goes on. In the end, I am not exactly sure why the patient came to me when EVERY treatment I offered was rejected. This does not mean to accept any treatment blindly and without question. On the contrary, be open to any and all suggestions and try to stay away from biases that carry over from rumors and hearsay. Evaluate each piece of advice with an open mind and then make a decision.
- Surgery is neither aggressive nor conservative. Surgery has a role in back pain, but not a large role. When properly indicated, surgery will always be a good choice. When not indicated, it is unnecessary and a problem for the patient. Get 2-3 opinions if surgery is recommended.
- Don't be afraid to take it easy for some time period. You may not be able to return to 10 mile runs for 6-8 weeks. This is not the end of the world. Respect the pain and the injury. If you do not, your back will tell you.
- Try to return to reasonable activities and work as soon as you are cleared to do this. Too many people stay out of the mainstream of work and this causes a culture of not wanting to get better. If your doctor feels it's safe to return to work in some capacity, then you should do so.
- Make sure you do all you can to get a real diagnosis. If the doctor was with you for 3 minutes and never laid a hand on you, the diagnosis of back strain is probably wrong. A good history and physical examination is often correct 85-90% of the time. Tests like MRI's should be used to either confirm a diagnosis already known or to distinguish between one or two different diagnoses. Since many people over age 50 have significant findings on their MRI even if these patients do not have back pain, be careful with MRI's not connected to a comprehensive office visit. The finding in the office needs to correlate with any test.
Dr. K.
(WebMD-Ten Ways to Manage Back Pain)
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