“My back hurts, doc. What can I do?” Chronic low back pain is the fifth leading cause of visits to primary care physicians and the single most common reason adults use complementary and integrative methods in the United States. Up to 20 percent of the population will develop chronic back pain, and 35 percent of those with back pain episodes will suffer a recurrence despite any treatment.

The rate of deaths from overdoses for prescription opiates has been escalating since the early 2000s. Twenty percent or more of suicide cases have opiates on board. Meanwhile, deaths from cocaine and heroin have remained largely unchanged. Death from marijuana overdose is essentially zero, another argument for adopting its use medically in chronic pain, cancer and post-traumatic stress disorder. It has been approved for medical use in two dozen states and the District of Columbia.

As a result, many sufferers seek relief of their back pain daily in their medical care. At a recent presentation, I described some non-drug options for back pain, which I would like to share with you here.

I recommend a stepped care approach:

1. Mindfulness, breathing methods, relaxation and stress management methods.

2. Movement therapy such as physical therapy, tai chi, yoga, aquatherapy, resistance, aerobics, as well as an anti-inflammatory diet.

3. Acupuncture, chiropractic, massage, hypnosis, botanicals and dietary supplements; biofeedback and cognitive behavioral therapies.

4. Medication, pain clinic consultation, injections and surgery.

It turns out patient education is a key factor in back pain. Encouraging movement and the notion of motion as lotion is central. Back pain patients are often disabled mentally as well as physically by fear of movement. Reassuring them that most back pain, though uncomfortable, is benign in nature and they will ultimately do well. Essential to a positive long-term prognosis is staying active as much as possible.

Though surgery, epidural injections, anesthesia and pain clinic consultations, implantable stimulators and drug pumps remain as high-tech options, these are not universally effective. Thus, before prescribing potentially habit-forming drugs in escalating and risky doses, we recommend implementing a holistic treatment plan as described in the stepped care plan above.

Pain is a complex phenomena and assessing its cause and impact in people’s lives is essential. Such factors as understanding expectations, health care beliefs, stress, co-morbid mood disorders, frustration, guilt, perceptions about the problem and willingness to be an active participant in care are highly important. Addressing sleep, fatigue, deconditioning from lack of activity and fear avoidance, obesity and inflammation are part of a team approach to prevent physical and psychological disability.

Some supplements that may be used are:
• Curcumin

• Boswellia

• Ginger

• Glucosamine Sulfate/Chondroitin Sulfate

• Zyflamend

• Omega 3’s

• SAMe

• Devil’s claw

The care of your back pain is a team approach. Local resources include the University of Texas Medical Branch or other physical therapy programs, Tideways aquatherapy, several well-respected regional chiropractors and massage therapists. Qualified local acupuncturists include Mary Ellen Bestani, Clint McCallum, Paul Abadie, the team at Health Matters and me at Island West Clinic.

Remember the motto of the healers who are doing our best to help you: Cure sometimes, relieve often and comfort always.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.