Feature Articles


Pain in the Back

Low back pain is incredibly common but difficult to treat. Here's how doctors' Rx are evolving and what treatments are proving most effective.
Pain in the Back
By Elizabeth Marglin
Published: July 23, 2015
Last updated: June 15, 2016

By Elizabeth Marglin
Most of the 56 million Americans who suffer from chronic low back pain are told to just take acetaminophen. The problem? It does little to relieve their discomfort. A recent study published in the British Medical Journal bears this out: Researchers concluded that Tylenol and other products containing acetaminophen were no more effective than a placebo for more than 1,600 people suffering from acute lower back pain. Prescription painkillers can provide relief in the short term, but because of their serious side effects, doctors are more and more reluctant to prescribe them. But the good news is that newer, drug-free treatments are gaining traction.

Back pain usually starts with muscle spasms — debilitating pain for short periods of time — typically triggered not by traumatic events but by mild tweaks.

“More than 70% of all adults experience disabling back pain at some point. It’s the most common cause of job-related disability and the reason behind most missed workdays,” says Rowland Hazard, MD, director of the Functional Restoration Program at Dartmouth-Hitchcock Medical Center in New Hampshire.

More than a quarter of adults — a figure Dr. Hazard puts at 30% — reported experiencing low back pain during the past 3 months.

Once back pain episodes become more frequent and intense, doctors might refer patients to spinal and orthopedic surgeons or order an MRI or other form of  imaging. They might learn that their particular brand of pain is the result of spondylitis (a type of arthritis that affects the spine), spinal stenosis (narrowing of the spaces between the bones of the spine, which can create pressure on the spinal cord and nerves), arthritis or degenerative disc disease.

Acute back pain tends to resolve itself after several weeks, but for people with chronic pain, it keeps recurring — and might, in fact, never go away.

Why Back Pain Diagnoses Are Evolving

Although it’s a remarkably common health issue, back pain is tricky to treat. Even with the sophisticated imaging tools at a doctor’s disposal, such as Magnetic Resonance Imaging (MRIs), often there’s no clear anatomical diagnosis.

‘We’re spending billions of dollars every year on treatment, MRIs, opioids and surgeries for people with back pain,’ Dr. Hazard says. ‘At the same time, there’s a disconnect. People are not feeling better.’

“A lot of images have false positives. Things will show up that are age-related but are not what’s causing the person’s trauma,” says Dr. Hazard. “Confusion and frustration arises from the difficulty of being able to make a specific diagnosis.”

And the rate of disability claims due to back pain are growing despite how much money we throw at the problem.
Back Pain and Disability
To improve treatment outcomes, doctors are beginning to shift their approaches to back pain. It’s no longer seen as a symptom, but a disease in and of itself. The spine is complex, and the pain can have a clear cause, such as a pinched nerve or herniated disc.

But it can also be a symptom of other medical conditions going on with the patient. Obesity and sedentary lifestyles, for example, also can set the stage for low back pain.

“In the last 5 years or so, a tidal wave of research demonstrates that sedentariness is substantially more impactful than previously thought,” says Stephen West, BS, RMT, a massage therapist based in Boulder, Colorado. “And the effects of sitting for 8 hours a day, on average, are not overcome merely by working out for 1 to 2 hours a day.”

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