By Dr. Victor S. Sierpina
Back pain is one of the top five causes for visits to primary care physicians and afflicts an estimated 60-85 percent of people during the course of their life.
My first intense experience with back pain was watching two strong men help carry my father, a tough heavy equipment and auto mechanic, out the front door to a doctor when I was about 8.
My dad worked on commission and was the sole support of our family. It was a scary moment to see my invulnerable father in such pain and unable to function.
Fortunately, most of the time, a back ache or sprain is self-limiting, within a few weeks responding to initial rest, progressive exercise and stretching, mild pain management such as anti-inflammatories, muscle relaxants, acetaminophen, heat, etc.
Some folks respond well to massage, chiropractic or osteopathic manipulation so these ought to be considered along with such helpful modalities as physical therapy and water therapy.
Acupuncture also is useful but is more commonly applied for the chronic cases of back pain.
Chronic low back pain is a challenging condition to treat as well as to live with. Surgery is usually of limited benefit except in the situations in which there is a neurological deficit. Even most cases of herniated discs tend to get better with time, not surgical intervention.
Newer techniques such as steroid injections can be useful but are disappointing in many cases. Most back pain problems defy anatomical diagnosis, and it is usually not necessary to be excessively precise on the cause of chronic back pain as this can be expensive, create negative expectations and doesn’t affect the clinical approach.
Uncommon causes that need to be excluded are fractures, inflammatory disease, infections and cancer. In older patients, osteoarthritis or spinal stenosis are common contributing causes of back pain.
The most troubling cases faced by physicians are those patients disabled from — or seeking disability because of — their chronic back pain. While there are certainly legitimate conditions that cause back pain related disability, it turns out that psychosocial and occupational factors play an import significant role in how chronic back pain is perceived and experienced.
Many of those disabled from low back problems have significant depression or other psychiatric problems, lack social support and are prone to substance dependence.
Studies have shown that predictors for disability from chronic low back pain include inappropriate attitudes and beliefs about back pain, poor or maladaptive coping strategies, high levels of emotional distress, fear avoidance beliefs, resistance to change and family reinforcement of illness behavior.
Inactivity leads to a vicious cycle of disuse, deconditioning, stiffness, medication dependency, and further chronic pain. Work-related factors predicting disability include low work status and low job satisfaction, jobs with high physical demands with inability to modify work and overall poor working conditions.
Insurance, workers’ compensation and disability benefits factor into settlements as well. In countries without these safety nets in place, there are very low rates of disability from back pain compared to the U.S.
It turns out that education and self-care can play a major role in managing back pain and preventing disability.
At a glance
Here are some tips for living with back pain:
Stay active and carry on as normally as possible, being mindful that in most cases staying active might hurt but will not cause harm.
Lift properly by bending your knees and keeping your back straight.
Strengthen core muscles of abdomen and back, walk regularly and keep a healthy body weight.
Use stretching exercises for the back such as yoga, tai chi or specific low back exercises.
Consider herbal anti-inflammatories such as curcumin, ginger, boswellia and Zyflamend besides the usually prescribed anti-inflammatories and muscle relaxants. Avoid opiates unless absolutely necessary.
Utilize integrative approaches such as acupuncture, massage, chiropractic, osteopathy, physical therapy, aquatherapy, mind-body and relaxation techniques and exercises for at least a year before considering surgery. These recommendations are true only in the absence of red flag neurological symptoms such as incontinence, numbness or weakness in the legs.
Avoid imaging studies in most cases of chronic low back pain. Consult with your doctor on this decision, as many expensive studies such as MRI show bulging discs and other abnormalities even in normal people without back pain so they are not cost-effective or necessary and are rarely helpful in management.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.