Your Aching Back: Strategies to Ease the Pain

I know all about back pain. On Labor Day 2001, I injured my lower back while vacuuming for my elderly mom. And it hurt. A lot. Somehow I managed to survive three hours of Labor Day gridlock on I-95; sit on a commuter train for two hours; and take two subway trains to my apartment in New York City, while lugging two heavy bags.

The next day I went—well, more like hobbled—to work.  As long as I sat, I was OK but when I stood, I felt like howling. On Wednesday, in agony, I called an orthopedist—and then several more. No one would see someone with low back pain. Finally one doctor referred me to a physiatrist—a doctor who specializes in physical medicine and rehabilitation—and I snagged an appointment for Thursday.

After examining me, he ordered an MRI, which pinpointed the culprit: I had ruptured a disc in my lower back. I was put on a seven-day course of oral corticosteroids and told to rest. I stayed in bed until Sunday when, bored out my mind, I took a long walk. The next day I went to work. By the end of week two, still in pain, my physiatrist gave me spinal injections to relieve muscle spasms, prescribed twice-weekly back massages and sent me to a physical therapist, who provided me with home exercises to stretch and strengthen my back muscles. Slowly my pain eased and by the end of three weeks, I was feeling pretty good. Two months out, I was back to normal. I was lucky. I had found a doctor who understood back pain and I responded to his treatment regimen.

Something else worked in my favor:  My refusal to take it easy. Staying active, it turns out, is one of the best things you can do for low back pain. Nine years later, my back is fine. Once in a while I feel a twinge and when I do, I change my position and do back stretches. If my muscles tighten, I have a massage. I wish everyone were as lucky. Back pain is a drag and one of the most common reasons people visit their family doctors, according to a report in the journal American Family Physician.

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In the search for low back pain relief, we fork over an estimated $30 billion per year. Backs ache for all sorts of reasons—including disc problems, strains, sprains and compression fractures. The good news: Nearly a third of us feel better within a week and most of us bounce back within 12 weeks, according to the American Family Physician report.

The not-so-good news: Plenty more are dogged by pain. In fact, back discomfort recurs in about 40% of people within six months. What should you do then? Every case is different and studies regularly come out for and against all sorts of treatments. But here’s a general guide to approaches and treatments worth trying if your back acts up:

• See your doctor—if the pain lasts more than three days or it’s severe. Most of the time back pain will heal on its own. But your doctor should rule out more serious causes such as disease or infection.

• Try an over-the-counter painkiller like aspirin, acetaminophen, naproxen or ibuprofen to take the edge off the pain and ease inflammation. Since OTC medicines have side effects, discuss the pros and cons of each with your physician. Prescription opioids control pain when OTC medicines don’t, but shouldn’t be used indefinitely. Muscle relaxants also help, but have side effects. While corticosteroids worked for me, there’s no evidence that they help low back pain.

• Limit bed rest to one to two days. After that, do as I did: Move. Stretching, walking, swimming, yoga and even strength-training can help you heal. Canadian researchers found that people with chronic back pain who strength trained for 16 weeks saw their pain and ability to function improve by about 60%. By contrast people who walked on a treadmill or jogged saw a 12% improvement. Another study found that minorities who took weekly 75-minute yoga classes for three months—and were encouraged to practice yoga at home for 30 minutes the rest of the time—reduced back pain by one-third and the use of pain medicine by 80%. A caveat: Get your doctor’s OK before you exercise, and see a physical therapist, who can show you proper form and determine what and how much you can safely do.

• Try heating pads. There’s evidence heat therapy is more effective than cold.

• Don’t rule out acupuncture. A report in the Archives of Internal Medicine found that acupuncture seems to be better than usual care—it includes strategies like medicine and physical therapy—at reducing pain and improving function. But simulated acupuncture, using a toothpick instead of a needle, worked as well as the real deal.

• Schedule a massage. I can vouch for this. Not only does massage feel great, it works. In one study, 262 back pain patients were followed for 10 weeks. Some were prescribed 10 sessions of massage, some had 10 sessions of acupuncture and some were assigned to a self-care group, consisting of a book and videotapes on back pain. At the 10-week mark, 74% of people rated the massages as “very helpful,” compared to 46% of those who had acupuncture. By contrast, 26% thought the videotapes were helpful and 17% thought the book was.

• See a chiropractor. While some studies on chiropractic care and back pain have shown mixed results, others have found improvements in pain. Just make sure your practitioner is accredited.

• Consider surgery as a last resort. Plenty of people feel terrific after back surgery, but many don’t. Make sure you understand the risks of surgery, how long it’ll take you to recover and what you can realistically expect.

Yours in health,

Catherine Winters
Contributing Editor
New England Health Advisory

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