Treating Back Pain
by Constance Young

I am one of the 80 percent of Americans who at some time or other have suffered from back pain—Like many of my friends of a certain age I have osteoarthritis, which can trigger the condition. Other causes of low back pain are simpler, the simplest probably being a strained muscle. Whether the cause is straightforward or complex, back problems result in hours, days, even months of pain and frustration.

Back pain that first appears in something as small as bending down to tie a shoelace might have an underlying cause. Years of strain or a chronic condition could have weakened structures in and around the spine. Back pain from any cause can be acute, lasting around six weeks; or chronic, lasting from three to six months or more.

For acute cases of back pain, the best and simplest course of action is rest and the application of ice to the painful area, in 20-minute intervals, followed, usually after about 72 hours, by heat. Cold reduces inflammation and heat soothes muscles and helps relieve muscle spasms.

After a long and perplexing medical odyssey, I learned that my back pain is largely attributable to spinal stenosis. In non-medicalese: two or more areas of my spine have become narrowed, putting pressure on the spinal cord.

My personal journey to locate the cause of my low back pain took me through a perplexing maze of referrals, tests, and often incomplete information and advice. It included my primary care physician’s recommended X-rays and MRIs of my back and referral to a neurologist (I did not comply); visits to a rheumatologist; several referrals to physical therapists, some helpful, some not; and a referral to an osteopath, who I am still seeing. Along the way I also saw an acupuncturist and a homeopathic health practitioner.

First Stop: Primary Care Physician or ER
When back pain that has built up gradually over time reaches a tipping point, the usual first stop is a primary care physician. She or he will most likely recommend measures to reduce pain—such as over-the-counter NSAIDs or anti-inflamma-tory drugs such as ibuprofen (Motrin) or naproxen (Aleve), and in more severe cases stronger prescription drugs or steroid injections. Your primary care or ER doctor may also recommend tests such as x-rays, CT scans or an MRI to get to the cause of the pain or refer you to a specialist, such as an orthopedic surgeon, rheumatologist or neurologist.

Physical Therapy
Physical therapy combined with NSAIDs is probably the most effective treatment for degenerative discs. Physical therapists (PTs) incorporate many different techniques. Active methods include stretching and strengthening exercises and low-impact aerobics designed to lessen pain and increase function. Passive approaches include heat, physical manipulation, and ultrasound. PTs also sometimes show patients how to move, stand, or sit to avoid pain and offer other treatment, such as medications and referrals to other healthcare practitioners. It’s not always easy to find the best therapist for a particular situation. One therapist treated my cervical spine so aggressively that I ended up in the ER with a severe migraine and vertigo. In my opinion, physical therapy is as much an art as a science. Once I finally found a good PT, I soon realized that she provided the best treatment for most of my pains.

Osteopathic medicine
Another good find during my odyssey is osteo-pathy. Osteopaths are physicians who require roughly the same number of years of medical school and training as traditional physicians, but are taught to adopt a more holistic approach. According to osteopath Ari Rosen, osteopathy tries “to create an environment in which the body can heal itself.” Here’s an example from my own experience. I had a cartilage tear in my knee, so I naturally favored the other side of my body, which in turn caused misalignment and back pain. Dr. Rosen relieved my pain using gentle, hands-on manipulative treatments.

Like traditional physicians, osteopaths specialize. In fact, the majority of them practice medicine very similarly to MDs. Osteopaths treating back pain may order tests in non-healing, complicated cases; and if a physical and neurological exam reveals a dire medical problem, they might refer a patient to a neurologist, neurosurgeon, or back to their primary care physician. Osteopaths usually recommend exercises and behavioral modifications.

Chiropractic
Chiropractic treatment is most often the first choice among people seeking “alternative” treatment for back pain. About 22 million Americans visit chiropractors annually, 35 percent of them for relief of back pain of various causes. Personally I have shied away from chiropractic because of stories I have heard and knowing that chiropractic training by itself is not as extensive as that for traditional or osteopathic physicians. Chiropractors use a special brand of physical manipulation of the spine, spinal adjustment—applying with their hands a controlled sudden force to a joint—pushing it beyond its normal range of motion, causing a popping or cracking sound— in an effort to restore movement, improve function and decrease pain. Chiropractors may also use massage and stretching to relax muscles in spasm.

Chiropractic care is not for everyone—particularly if there are signs of osteoporosis, numbness or nerve damage, spinal surgery, or “red flag” symptoms.

Other Treatments
Americans also frequently use alternative approaches to treat low back pain. Acupuncture uses hair-thin needles under the skin that relieve pain, apparently by releasing endorphins, the body’s natural painkillers. Performed by an experienced and skilled technician, I found acupuncture to be quite helpful in reducing my pain, but it is costly and most insurance plans don’t cover it (physical therapy and osteopathy usually are covered). Yoga, ultrasound and biofeedback are among other alternative modalities.

Surgery, the last resort. Surgery is an absolute last resort as a treatment for most back pain (except when it is required during an emergency). Fewer than one in 100 people need surgery for back pain.