by Timothy Carey, MD, MPHÂ Â
Back pain — itâs not so much a question of if youâll get it, but when. Four out of five people experience annoying lower back pain at some time in life… and itâs natural to want to do something to fix it. But before you do, know this: The scientific evidence now shows that for lower back pain, waiting it out is just about as effective as more dramatic (and risky) treatments, such as surgery, narcotics and steroids.
Â Back Attack
Â Before we go further with this, though, we need to be clear on one point. Back pain that is of sudden onset due to a fall or blow to the back, or accompanied by other symptoms that could indicate a heart attack or other medical emergency requires an immediate trip to the ER. And if you experience back pain and you also have other medical issues (such as cancer or neurological problems), see your doctor to be sure it isnât a sign that something else is going on.
A Â study published in the medical journal Spine, reported that people with back pain were getting complicated treatments that donât help and may in fact cause harm… while less than half get a prescription for the safe, effective and simple self-treatment proven to make things better — which is exercise. I called the study author, Timothy Carey, MD, professor of social medicine at University of North Carolina, Chapel Hill, and director of the Cecil G. Sheps Center for Health Services Research, to ask some questions. Dr. Carey told me that low back pain does not always require tests, such as CT scans or MRIs. Unless you have a history of cancer, osteoporosis, fever, weight loss (these are sometimes called red-flag symptoms) or current muscle weakness or urinary difficulty, it probably makes sense to wait one month before proceeding with such tests.
Â Why Tests May Cause Harm
Â A recent study from Stanford University showed that in regions of the US where there is lots of MRI technology available, there are far more back surgeries — and also that having an MRI early in the course of back pain not only doesnât tend to lead to a better outcome, it may actually induce health-care providers to suggest unneeded surgery. Aggressive use of CT scans also can lead to overtreatment, Dr. Carey noted. “These imaging techniques provide wonderful pictures of the anatomy of the back, but the images are only loosely correlated with how the back functions,” he said.
Â Dr. Careyâs advice: Before agreeing to undergo an imaging procedure, discuss with your doctor what next steps are being considered. As Dr. Carey points out, “if the results arenât going to change treatment, then thereâs not a good reason to get the test.”
Â We all know the dangers of narcotic drugs, which are often overused for back pain, Dr. Carey told me. He authored a study (also reported in the journal Spine) that looked at 732 people with chronic low back pain that had lasted longer than three months. Sixty-one percent had been treated with narcotics. “These can have significant side effects and can be habit forming, and thereâs very little evidence that they work well to improve patientsâ functioning,” he added.
Â Whatâs a Back Patient To Do?
Â Meanwhile, only half the respondents in Dr. Careyâs study had been given a prescription for exercise even though thereâs strong evidence that engaging in aerobic exercise several times a week helps alleviate back pain. He told me that exercise can be very effective if you take it seriously as a therapy and really do it. “Just as you take a medication at a specific dose, a specific number of times a day, for a specific number of days, exercise also needs to be structured,” he explained. If you arenât particularly fit or havenât been exercising, Dr. Carey advises walking briskly 10 minutes a day for the first week, then checking with your doctor before extending your workout to 20 and eventually to 30 minutes a day.
Â Try this: Also good are range of motion exercises for the spine, such as slow rotations. Gradually (over 30 seconds or so) bend from one side through the front and then on to the other side — then reverse the movement. Do this for five to 10 minutes before aerobic exercise, said Dr. Carey. The stretching and strengthening that yoga offers can be helpful in relieving back pain, too. He said it’s best to “get out and get moving,” noting that prolonged bed rest is bad for the back and should be avoided. He acknowledged that people with back pain may find exercise increases their discomfort initially, but he urges sticking with it. “Youâre not damaging your back, and after a week or two, the pain level will start to decline,” he said.
Â If you do need a pain reliever, several are effective and safe when taken for a short time. These include acetaminophen (Tylenol)… over-the-counter NSAIDs such as ibuprofen (Advil)… and prescription muscle relaxants, such as cyclobenzaprine (Flexeril), especially if youâre having trouble sleeping. All muscle relaxants tend to be sedating, so be cautious if youâre going to drive, and never combine them with alcohol.
Â You may have an uncomfortable week or two while recovering from benign low back pain but, with patience and conservative treatment, most such back pain improves, notes Dr. Carey. In a small number of cases, the pain doesnât improve — and then it may be time for more doctor visits and tests.
Timothy Carey, MD, MPH, professor of social medicine, University of North Carolina, Chapel Hill, and director of The Cecil G. Sheps Center for Health Services Research, Chapel Hill