The stubbornness and aggravation of back pain afflicts an estimated 540 million people worldwide. At least 80% of Americans have complained of significant back pain at some point(s) in their lives. Severe back pain is the 5th most common reason for doctor visits in the US and 40% of all workplace absences are due to back issues. The following is the latest science on this persistent scourge.
The back is so complex there is often
no specific area that can be repaired:
“But perhaps the most helpful thing we can do is challenge
the assumption that, if our back hurts, there is a pain generator in there
somewhere that can be scanned, identified, injected or surgically removed, and
fixed. ‘That whole notion is erroneous,’ says
Cathryn Jakobson Ramin (investigative journalist who exposed the US back
industry). ‘The truth is that low back pain is a many-faceted problem, emerging
from your life situation, the state of your body and the social factors
surrounding you.’ Rather than trying to find a doctor who can make the pain
disappear, we need to be aware that to a certain degree, it is a part of life
and the best approach is to keep physically active in the right way, to find a
strategy to manage stress and to keep on with normal activities. Like all
complicated pain, avoiding it, trying to use a substance to blot it out,
investing in one person the belief that he or she can cure you: that all makes
it worse.”
Invasive back
treatments such as injections and surgery are often unnecessary:
“(At) an American Academy of Orthopedic Surgeons conference in 2010, 100
surgeons were asked whether they would have surgery on their spine for
nonspecific low back pain. The answer – from all but one – was ‘absolutely
not’. Spinal fusion surgery, which is sometimes recommended when disc
degeneration is identified on an MRI, is a procedure in which the offending
disc is cut out and the surrounding vertebrae are re-connected, either with
bone graft or with titanium screws and plates.
“At best, these spine surgeons define success as a 38% improvement in
pain and function ….. but if a hip or a knee surgeon had a 38% success rate,
that physician would no longer do that surgery.”
MRI scans that attempt to diagnose
lower back pain may do more harm than good:
“When
it comes to diagnosing most back pain, MRI machines are like Monty Python’s
medical machinery that goes ‘bing.’ For back pain, MRI and X-ray are medical
machines that make false alarms…..
“They
don’t always make false alarms, of course. MRI is a miracle technology, no
doubt about it — the ability to get clear images of soft tissues deep inside
the body is valuable, and extremely tempting for everyone involved.MRI can
shine when it’s actually needed and done well…..
“But
the sad truth is that it’s not needed anywhere near as much as it is actually
used, and it’s especially not needed for most low back pain. And not doing it
well? That’s just normal: radiology reports are usually written without
clinical context, and frequently presented to the patient like diagnoses. But
low back pain experts have long understood that you simply cannot reliably
diagnose low back pain with MRI or with X-ray in isolation — and trying to do
so reliably raises false alarms that actually do harm. Premature MRI is
actually often worse than useless.”
Drugs for back pain should be taken
only after thoughtful consideration and consultation:
"NSAIDs (non-steroidal
anti-inflammatory drugs) are often the go-to drugs for back pain relief. They
can be purchased over the counter (or, in higher doses, by prescription) and
include ibuprofen (Advil) and naproxen (Aleve).
“NSAIDs help reduce pain, swelling, and inflammation in muscles and
around damaged spinal discs or arthritic joints. Acetaminophen (Tylenol) is
also a pain reliever and often sold alongside NSAIDs, but it's not an NSAID and
does not help with inflammation…..
“Because NSAIDs are easy to get, people tend to overuse them, which can
expose them to possible side effects like stomach pain, ulcers, bleeding, or
even kidney damage. There is no recommended standard dosage for NSAIDs for back
pain. ‘Follow the guidelines on the label, and let your doctor know what you are
taking and how much,’ says Dr. Shmerling (clinical chief of rheumatology at
Harvard-affiliated Beth Israel Deaconess Medical Center).
“Keep in mind that NSAIDs might not always be the best medicine for back
pain. A study published online Feb. 2, 2017, by Annals of the Rheumatic
Diseases reviewed 35 placebo-controlled studies that included more
than 6,000 people who had all sorts of spine-related pain, including neck pain,
low back pain, and sciatica. While people who took NSAIDs had less pain and
disability after starting treatment than before, the effect was quite small and
similar to improvements reported by those who received a placebo.
“Also, those who took NSAIDs were two-and-a-half times more likely to
experience side effects. ‘This doesn't mean that NSAIDs can't help you, but
only that they don't work for everyone,’ says Dr. Shmerling.”
Opioids are not effective
for non-surgical acute and chronic low back pain:
“Consequences of prescription opioid use involve harms, addiction,
tolerance and death. Despite routine prescription, opioids are not recommended
for initial intervention by any major multidisciplinary low back pain (LBP)
guideline…..
“Opioids were not shown to be superior to other medications, and only
showed superiority to placebo comparators (at cost of additional harms). This
review identified trends of higher harms rates and higher percentages of severe
harms in opioid arms for the management of sub-acute and chronic LBP. The
majority of trials that demonstrated benefits with opioids also had potential
conflicts of interest. Lastly, non-opioid medications demonstrated
statistically significant pain improvement compared with opioids. We feel that
the results of the trial are supportive of current LBP guidelines and do not
condone the initial use of opioids in management of sub-acute or chronic LBP.”
Stem cell scam
artists are already promising miracle “cures” for back problems:
“(This) investigation highlights the serious potential risks
to patients of stem cell therapies administered for unapproved and unproven
uses other than hematopoietic or immunologic reconstitution. Although the
safety and efficacy of stem cells for other than hematopoietic or immunologic
reconstitution have not been well established, many companies, clinics, and
clinicians continue to market products from various sources as treatment for orthopedic,
neurologic, and rheumatologic conditions without FDA approval.
“Such clinics and providers operate in outpatient settings,
which often have less robust oversight of infection control measures, including
injection safety and medication preparation, potentially amplifying risk to
patients. Therefore, FDA has recommended that patients avoid receiving such
products outside controlled clinical studies being conducted under an
investigational new drug application; these settings help ensure that
appropriate manufacturing and safety reporting procedures are followed.”
Smoking can only exacerbate back
problems:
“The
evidence is strong enough that ‘I think we can, with a fairly high degree of
certainty, link smoking to multiple negative outcomes,’ says Dr. Crawford
Barnett, a pain management specialist at Cleveland Clinic Hillcrest Hospital in
Cleveland. Research finds that lighting up is linked to higher rates of
osteoporosis, lumbar disc diseases – or those that affect the lower back – as
well as increased problems with bone healing. And studies show those who smoke
who suffer spine injuries or from other back problems that turn out to be
short-term issues for some, tend to have a greater chance of going on to
develop chronic pain as a result.”
Attitude and
lifestyle are integral in dealing with back pain:
“Traditionally we have thought of pain as a signal transmitted from the
periphery to the brain – such as when a finger touches a hot plate. This
understanding of pain serves well for very brief acute pain; however, it is
only a small part of the story when pain is longer lasting.
“Just as there are nerve tracts that carry pain signals upward to the
brain, there are also tracts coming down from the brain that regulate the
sensitivity of the spinal cord and thus determine how much pain we perceive.
These tracts can amplify pain – making a trivial stimulation seem terrible –
and can block it, which probably explains why quarterbacks and combat soldiers
can carry out remarkable activities, and only after some time realize that
they’ve been injured……..
“Psychological factors rarely seem to be an important cause of prolonged
pain, but they invariably affect it – for better or for worse. Attention and
vigilance account for much of the psychological modulation of pain. Pain that
the brain thinks is important will be amplified, and those that it thinks are
of no consequence will be lessened. (Just as a mother in a noisy New York
apartment sleeps soundly as ambulances and car horns sound through the night,
but awakens instantly when her baby whimpers.)
“Mood profoundly affects pain, and even something as simple as reading a
short story that it either funny or tragic changes people’s thresholds and
tolerance to experimental pain. Research over the last 35 years has
demonstrated that pain, as well as numerous other factors, change the central
nervous system in ways that lead to prolonged pain, even when the illness or
injury that initiated it has healed. In fact, most chronic pain is more
attributable to sensitization of the nervous system than to problems in the
body parts that hurt……..
“Catastrophizing,
the tendency to assume that the worst that can happen is true, has been shown
to promote pain and dysfunction. In the case of back pain, a person whose thoughts
tend to run in the direction of, ‘This is horrible, there’s no way I can stand
it, I’m damaged for the rest of my life,’ will likely suffer more (and have
less fun) than one who thinks, ‘the majority of people have back pain, and I’m
getting more than my share of it, but I know there will be days that are better
and days that are worse.’"
A
summary of the benefits of exercise:
“Back pain is a major health issue in Western countries and
60%–80% of adults are likely to experience low back pain. This paper explores
the impact of back pain on society and the role of physical activity for
treatment of non-specific low back pain. A review of the literature was carried
out using the databases SPORT-Discuss, Medline and Google Scholar. A general
exercise program that combines muscular strength, flexibility and aerobic
fitness is beneficial for rehabilitation of non-specific chronic low back pain.
Increasing core muscular strength can assist in supporting the lumbar spine.
Improving the flexibility of the muscle-tendons and ligaments in the back
increases the range of motion and assists with the patient’s functional
movement. Aerobic exercise increases the blood flow and nutrients to the soft
tissues in the back, improving the healing process and reducing stiffness that
can result in back pain.”
Recommendations
for a healthy back:
----Always stretch before exercise or other strenuous
physical activity.
----Don’t slouch when standing or sitting. The lower
back can support a person’s weight most easily when the curvature is reduced.
When standing, keep your weight balanced on your feet.
----At home or work, make sure work surfaces are at a
comfortable height.
----Sit in a chair with good lumbar support and proper
position and height for the task. Keep shoulders back. Switch sitting positions
often and periodically walk around the office or gently stretch muscles to
relieve tension. A pillow or rolled-up towel placed behind the small of the
back can provide some lumbar support. During prolonged periods of sitting,
elevate feet on a low stool or a stack of books.
----Wear comfortable, low-heeled shoes.
----Sleeping on one’s side with the knees drawn up in
a fetal position can help open up the joints in the spine and relieve pressure
by reducing the curvature of the spine. Always sleep on a firm surface.
----Don’t try to lift objects that are too heavy. Lift
from the knees, pull the stomach muscles in, and keep the head down and in line
with a straight back. When lifting, keep objects close to the body. Do not
twist when lifting.
----Maintain proper nutrition and diet to reduce and
prevent excessive weight gain, especially weight around the waistline that
taxes lower back muscles. A diet with sufficient daily intake of calcium,
phosphorus, and vitamin D helps to promote new bone growth.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
Additional Info
Lower Back Pain: Common Causes and Prevention For Athletes
Here’s some valuable information if you suffer from back pain https://fitnessvolt.com/lower-back-pain-athletes/
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Lower Back Pain: Common Causes and Prevention For Athletes
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Photo: https://www.emedicinehealth.com/back_pain_health/article_em.htm
Jerry De Luca is a Christian freelance writer who loves perusing dozens of interesting and informative publications. When he finds any useful info he summarizes it, taking the main points, and creates a (hopefully) helpful blog post.
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