Most Back Pain Can Be Treated Without Surgery
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
Back pain is one of the most common reasons why Americans visit doctors. The U.S. Department of Health and Human Services says back pain leads to more than 19 million doctor visits a year, and ranks third among Americans over the age of 40 as a reason for going to the doctor, behind only heart disease and arthritis.
The fact is that 80 percent of people will have back pain at some point. It accounts for up to $50 billion a year in lost productivity in the U.S. alone.
"It's an expensive and large problem," says
Dr. John Keel, Medical Director of the
Spine Center at Beth Israel Deaconess Medical Center.
But don't despair. There is hope. And it rarely requires surgery.
"The fact is that up to 90 percent of acute back pain episodes will resolve within 12 weeks," Dr. Keel says. "Up to half will resolve within the first week. Only a very small percentage of acute back pain episodes will require surgery. Most will respond to conservative care."
Back pain comes in a variety of forms, ranging from acute injuries stemming from the improper lifting of heavy objects to chronic pain as a result of too much sitting -- this is common among truck drivers -- to age-related pain from a worn out or arthritic disc or joint. In some cases, where a nerve root is involved, pain can shoot all the way down the leg.
In most cases, patients are encouraged to maintain their regular activities as much as possible. "Bed rest is not advised," Dr. Keel says. "It can make things worse."
In some cases, patients will be prescribed medications such as non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or muscle relaxants. Opioid medications are generally not needed as a first resort, but may have utility for certain patients.
Patients should be screened first for "red flags" which may indicate an underlying condition that may be causing the back pain, Dr. Keel says. These include recent trauma, fever, a history of cancer, progressive neurological problems, and bowel or bladder dysfunction.
There is usually no reason for an imaging study such as an MRI right away as most cases of back pain will resolve on their own. In addition, these highly sensitive and costly tests can find abnormalities that are insignificant and are not the cause of the pain, he notes. Other times, an MRI will show no problems, yet pain persists.
Dr. Keel says he is a big believer in physical therapy, both to help resolve acute pain and to strengthen the back to prevent future problems. Acupuncture and chiropractic also may be of some benefit, he notes. An analysis of numerous studies of back pain and acupuncture showed it was more effective for short-term pain relief than a "sham" treatment or no treatment at all, he notes.
Procedures such as injections of steroids or radiofrequency ablation, where radio waves are used to heat up tissue to deactivate sensory nerves, are also useful in some cases, he says.
Some doctors believe many cases of lower back pain are at least partly psychological in nature, the body's reaction to stress or emotional traumas.
Dr. Keel concedes that emotions can certainly play a role in chronic back pain. The pain, however, doesn't hurt any less, he notes.
In any case, he says, most people can be helped with their back pain, no matter the source.
"If you have back pain, you are not alone," he says. "Numerous medical specialties are interested in taking care of patients with back pain. It is such a common and important medical problem. But every case is different. Not all back pain is the same. That's why I believe in an individualized approach."
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.