Low Back Pain: Many Options for Relief
Without Surgery
Oct. 1, 2007 -- People who suffer low back pain have high odds of finding
relief without surgery, an expert panel says.
The panel, made up of experts from
the American Pain Society and the American College of Physicians, has released
guidelines for the diagnosis and treatment of low back pain.
The guidelines cover what doctors call "nonspecific low back pain" -- that is, back pain not due to a specific
condition such as cancer, a slipped disk, a compressed nerve, or a
fracture.
If you have this kind of bad pain, there's good news, says panelist Roger
Chou, MD, associate professor of medicine at Oregon Health & Science
University in Portland. Chou is director of the clinical guidelines development
program of the American Pain Society.
"There are lots of options out there that have pretty good evidence they
work," Chou tells WebMD. "There is no one perfect treatment for everybody. If
you are interested in spinal manipulation and acupuncture, the evidence is just
as good as for medications."
Once upon a time, doctors told people with low back pain to stay in bed for
three days -- perhaps with a board under their mattress. That very bad advice
actually made back pain worse, Chou says.
"We don't want people lying in bed," he says. "Get out. Try a normal range of
activities, but back off if your back hurts. But you won't hurt your back by
doing regular stuff, and it may actually keep your back conditioned and
strong."
Doctors also used to give routine X-rays to patients complaining of low back
pain. That, according to the expert panel, also is wrong. X-rays are
indicated only when a doctor has reason to suspect an underlying condition that
could be confirmed by imaging studies.
Back Pain Relief Menu
Most people with low back pain have an acute pain episode. But up to a third
of patients report persistent pain of at least moderate intensity -- chronic low
back pain.
The panel found evidence that different patients can get relief from a wide
variety of treatments. These treatments include:
- Cognitive-behavioral psychotherapy
- Exercise therapy
- Spinal manipulation from a chiropractor, osteopath, or physical therapist
- Intensive interdisciplinary rehabilitation (physical, vocational, and
behavioral therapies provided by multiple providers with different clinical
backgrounds) - Acupuncture
- Massage therapy
- Yoga
- Progressive relaxation
"Patients and doctors need to talk," Chou says. "Don't use stuff not backed
up by evidence. Don't fall for stuff just because it's touted on the Internet or
whatever."
Scott D. Boden, MD, professor of orthopaedic surgery and director of the
Emory University orthopaedics and spine center, says the panel's advice confirms
what back specialists have been saying for years.
"These programs have been around for 15 to 20 years," Boden tells WebMD.
"Some studies show they have a benefit, some not. A lot of this has to do with
the psychological makeup of patients."
Boden adds one more possible cure to Chou's list: time.
"Fortunately for most patients, it is just a short period of time where back
pain is absolutely debilitating," he says. "For some, the most important thing
is just the education that they are not falling apart, so they can to stop
searching for the cure and go on and live their lives."
Back Pain Relief Menu continued...
Both Boden and Chou stress that surgery is not the answer for most patients.
In fact, Consumer Reports this month listed back surgery as the No. 1
most overused medical treatment.
"Since surgery doesn't offer a
large advantage in most patients, the message is that most people will be able
to get better without surgery," Chou says. "If you can avoid it, you are going
to be better off."
Boden suggests that patients settle on a treatment that helps and warns that
some patients may never be totally cured of back pain.
"Unfortunately, while looking for a cure patients can run into surgery that
would be moderately risky with a small chance of success," Boden says. "Or they
could end up with something that is not necessarily dangerous, but equally
ineffective. There are a lot of new things that sound good, but the real back
pain options really haven't changed that much in decades."
Chou and colleagues report the panel findings in the Oct. 2 issue of the
Annals of Internal Medicine.
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