Certainly there has been no shortage of experts pronouncing that most back pain is due to "spinal instability," or repetitive stress injury, fibromyalgia, even psychological problems. As Dr. Richard Deyo, who directs the University of Washington group, writes, "Back pain management historically has been a series of fads and fashions."
The truth is that, in most cases, no one knows for sure what's happening. And even the assistance of high-tech medical tests, such as MRIs, yield fewer clues that some doctors let on.
For the Record
Los Angeles Times Monday August 28, 2000 Home Edition Health Part S Page 3 View Desk 2 inches; 51 words Type of Material: Correction
Back pain--A story about back pain in the July 24 Health section should have said that only 24--not all 33--of the vertebrae in the spinal column are separated by disks. The article also implied that a patient named Pamela Lloyd spoke directly with researcher Carol McPhillips-Tangum; in fact, Lloyd spoke with another researcher who worked with McPhillips-Tangum.
In 1994, doctors at Hoag Memorial Hospital Presbyterian in Newport Beach studied spinal MRIs of a wide range of people. The investigators found that damaged or bulging disks are not only common but also show up in half of people whose backs feel fine. "There's so little evidence to grasp onto," says Cherkin, "that each practitioner tends to understand the problem within the perspective of his or her own training."
This confusion not only drives patients to distraction; it may actually exacerbate back pain, according to a 1998 study. While working for Prudential Healthcare, health researcher Carol McPhillips-Tangum conducted extensive interviews of 54 patients with chronic back pain. She hoped to learn what their expectations were of doctors and whether they were satisfied with their treatment. She found that nothing so exasperated patients as a non-diagnosis. It only caused them to insist more strongly on their problem.
One patient, Pamela Lloyd of Atlanta, told the researcher, "I know in my heart of hearts that at least three of these doctors felt that I wasn't really in the kind of pain that I said I was in. They couldn't understand why I kept on hurting, when all these things indicated that I should be better. Well, the reason is because it didn't show up on all of their tests."
The pain is real, all right, and it is often frightening. That's why people talk of "wrenching" or "throwing out" their backs. It's one of only a few afflictions that can make a perfectly fit, healthy young adult suddenly gimp about like Father Time.
All the same, say back specialists, a backache is usually no more serious than a headache, as unlikely as it seems at the time. Often, it is the patient's insistence on a diagnosis and cure that can turn it into a medical condition that feels more disabling.
"I think people get scared when they don't get a diagnosis," says Cherkin. "They are afraid to move, when the best medicine is to resume normal activity. What we say is, 'Hurt does not mean harm.' It's completely counterintuitive, but it works."
The good news, specialists say, is that there are plenty of things you can do to reduce--if not banish--the hurt. The key is getting pain relief early. Like many specialists, McCarberg starts patients with pain relievers; then muscle relaxants, if necessary; and if they're not better after a week, he tries steroid shots in the back.
What's more, some big insurers such as Kaiser and Aetna US Healthcare now encourage patients and doctors to try a variety of alternative treatments rather than more aggressive treatment. All of the following approaches can reduce pain, virtually without side effects, doctors say. And the treatments often are covered by health insurers:
* Chiropractic. Some 20 million people a year go to chiropractors, and they have their reasons. In several large-scale studies, chiropractic has proved effective in reducing pain, at least in the first week or so after it strikes. Practitioners typically isolate a vertebra near the source of the pain, then perform an adjustment--pushing the joint through its natural motion.
* Physical Therapy. Physical therapists use a variety of massage, stretching and postural techniques to strengthen the back and allow patients to cope with pain. Many therapists use something called the McKenzie Method, an exercise program that includes side-bending and rotation movements, usually done while lying on the back or stomach.
* Massage. The long, gliding, kneading strokes of Swedish massage can ease pain, as can deep tissue techniques. In people with chronic pain, says Cherkin, regular massage sessions not only soothed symptoms but allowed a return to normal activities.
Many back pain veterans also swear by acupuncture, yoga or specialized postural-balance programs, such as the Alexander Technique. "I think you should be pretty optimistic, if you have pain," says Cherkin. "There are a lot of things out there to try, and everyone seems to respond to something."