My Aching Back : Common Back Pain Is One Affliction That Needn’t Necessarily Be Taken Lying Down

SOMETIMES ALL IT TAKES is an untied shoelace. You bend over, and that’s it--a shooting pain makes straightening up impossible. Are you doomed to lie on the floor for three or four weeks? Not necessarily.

Just a few years ago, most doctors would tell patients with back pain to lie absolutely flat on a firm surface for a couple of weeks and get up only for meals and to use the bathroom. Uncomplicated back pain, caused by inflammation of the muscles, is the most common kind of back ailment. Fortunately for those so afflicted (and the people who have to wait on them), the recommended treatment for this type of back pain has changed considerably.

Recent studies indicate that three or four days of bed rest are just as effective as two to three weeks. And doctors today are likely to encourage people recovering from back injuries to stand and take several short walks each day to maintain muscle strength rather than just lie around. The most important thing is to avoid sitting, which adds substantial stress to an injured back, during and immediately following the period of rest.

Back problems are seemingly ubiquitous--more than 75% of Americans will injure their backs at least once. Expensive medical care (diagnostic tests, doctors’ fees and surgery) coupled with the cost of time lost from work make back problems one of the most costly ailments in the nation; each year, Americans spend about $16 billion on their back troubles.

Fortunately, most back injuries are not considered serious--meaning that there is little chance of damage to nerves or other vital structures. People with back pain usually do not visit doctors; instead they treat their pain with over-the-counter remedies such as aspirin or other pain relievers and apply warm compresses to the sore area. According to Dr. Robert Swezy, author of “Good News for Bad Backs,” such treatment is quite reasonable. “Most people will be out of pain and back in action within a month--with or without medical treatment.”

There are times, however, when a person should see a doctor without delay. Uncomplicated back pain usually stays in one location. Pain that radiates into the legs or buttocks, numbness in the legs and disruption of bladder function are signals that nerves in the back may be at risk of sustaining permanent damage. Likewise, fever or chills, symptoms not usually associated with back injury, may signal a kidney infection that is causing the back pain.

Mild pain that does not improve after several weeks may also indicate that it’s time to turn to a doctor, who can utilize a host of tests and medications. X-rays and special scans are often used to diagnose different types of ailments. Muscle relaxants, tranquilizers and painkillers are old standbys, and recently, doctors have started offering other options.

A new electric device called a TENS (transcutaneous electric nerve stimulation) unit is used with increasing frequency (although its effectiveness is questionable). This instrument is attached to the back with small pads. Wires leading to the pads deliver low-level electrical current to the injured area. Although many doctors and patients say TENS provides relief, a recent study found that it offered no more benefit than did a placebo. Of course, that doesn’t mean it won’t work for some people.

Another alternative is chiropractic. Chiropractors are non-physicians trained in the physical manipulation and realignment of the spine. In the past, doctors have been quick to share stories about the ineffectiveness of chiropractors. But several recent studies have found that when chiropractic was compared to conventional medical treatment for uncomplicated back pain, the chiropractic treatment produced better results--people had a greater relief of pain, a more rapid return to work and a smaller chance of reoccurrence over the following two years.

When bed rest and medication or chiropractic treatment fail, the next step for many suffers has been referral to a surgeon. Annually, 200,000 people in the United States have back surgery. And although some serious conditions do require surgery, patients should consider this option with reservation.

Nancy, a 38-year-old high school teacher, thought that surgery would end her back pain. For nearly five years, she had suffered from periods of pain so intense that she was forced to stay home from work. After treating her condition with drugs and rest, she could bear it no more. She visited a surgeon, who offered her an operation but neglected to tell her about the possible downside: Researchers have discovered that as many as 30% of those who undergo back surgery find no relief from the pain, and often it gets worse. “For many people,” says Dr. Robert Debois, a physician and private health consultant, “back surgery is no panacea.”

Several months after Nancy’s surgery, her pain returned, and this time little could be done; once the back has been operated on, scar tissue makes future surgery in the same area is exceedingly difficult.

Debois stresses that, except for those with serious injury, people should consider surgery only as a last resort. “You have one shot for effective back surgery. If you use it for a mild disorder, then using it again, if the condition worsens, becomes far more difficult.”

Nancy was finally sent to a chiropractor. After many weeks of therapy and numerous hours of exercise, she is playing tennis again, carefully.

So when your home treatment has failed and your back hurts and you feel you should consult a physician, we suggest you see a general practitioner who is aware of the recent changes in back-pain treatment. If she or he concludes that a further workup is necessary, ask to be directed to a specialist who is also familiar with current research. And if the advice is for surgery, always consider obtaining a second opinion.

In spite of research advances, back pain continues to plague us. The best we can do is to try to prevent it: Regularly stretch the back; lift with the legs, rather than the back, and keep yourself, and your back, in good physical shape.