Experts Push Low-Tech Care for Back Pain

In a major departure from traditional practice, federal health officials said Thursday that the expensive tests and therapies typically used to diagnose and treat lower back pain are largely useless.

Instead they recommended over-the-counter pain medications, chiropractic and low-stress exercise, such as swimming or walking.

For most patients, symptoms will disappear on their own within a month, they said.

Acute lower back problems--pain or discomfort in the lower back or pain and numbness that moves down the leg (sciatica)--is a sometimes-debilitating condition suffered at some point by almost everyone.

In fact, after the common cold, it is the leading reason that people see their primary-care physicians, according to the federal government.

Back pain can occur at any point on the spine for no apparent reason, but it most commonly crops up in the lower back region because that area bears the majority of the body’s weight.

Lower back pain can severely restrict an individual’s activities, including the ability to work--sometimes for weeks. In 1990, more than $20 billion in direct medical costs was spent on the condition, mostly for diagnostic tests. The total annual cost--including lost productivity--is estimated at $50 billion.

The new guidelines were compiled by a panel of medical experts who reviewed nearly 4,000 studies. The group was convened by the federal Agency for Health Care Policy and Research, which released the recommendations that are expected to be regarded as the standard of care.

The panel did not address chronic lower back problems, which are the subject of ongoing studies. But it stressed that people with long-term problems represent fewer than 5% of those afflicted with lower back pain. This group may or may not include people with disk problems, depending on the extent or severity of their symptoms.

The guidelines will provide “new hope to those who are confused about the myriad of approaches to acute low back problems,” said Dr. Stanley J. Bigos, chairman of the panel and a professor of orthopedic surgery at the University of Washington School of Medicine in Seattle.

The panel said the early use of tests such as X-rays, computed tomography and magnetic resonance imaging should be discouraged unless symptoms indicate more serious underlying conditions, such as fractures, tumors, infections or spinal nerve root problems.

Also, the usual therapies--extended bed rest, muscle relaxants and surgery--can be unnecessary and, in some cases, harmful, the panel said.

Resting in bed for more than four days “can weaken muscles and bones and delay recovery,” the panel said.

Within the first three months of symptoms, surgery is only recommended for those with evidence of serious spinal problems or those with certain leg symptoms that result from nerve conditions, dislocations or fractures, the panel said. Surgery appears to benefit only about one out of 100 individuals with acute low back pain, the group said.

Instead, the group said the use of acetaminophen and non-steroidal anti-inflammatory drugs was safe and effective, as was walking, swimming or biking--activities that help maintain and build a patient’s tolerance to physical activity.

Chiropractic, which uses spinal manipulation to ease pain, was also found to be helpful, especially within the first four weeks of the onset of pain, the panel said.

The recommendations were a significant validation to the century-old discipline of chiropractic, as well as a rebuff to surgeons.

For many years, chiropractic was the object of criticism and scorn from the medical Establishment, despite growing consumer support. In recent years, however, it has begun to enjoy increasing credibility within mainstream medicine.

Noting that spinal manipulation is a drug-free, non-surgical, low-cost form of relief, Dr. Lowry Morton, chairman of the board of the American Chiropractic Assn., said he hoped the guidelines would encourage managed-care health plans and health maintenance organizations to include chiropractic within their coverage.

“Spinal manipulation is effective; it gets low back pain patients on their feet and back to work faster than any other form of care,” he said.

The panel also recommended ways to prevent back pain. These include engaging in regular exercise; wearing comfortable, low-heeled shoes; using work surfaces at a comfortable height and chairs with good lower back support; and the use of lumbar corsets by people whose jobs require frequent lifting.

Also, when lifting, individuals should avoid twisting, bending and reaching, and keep objects close to the body, the panel said.

Health Information: To hear more information about lower back pain, as well as other problems with muscles, bones and joints, call TimesLine at 808-8463 and press *5190.

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