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Back pain is a complicated issue

Most Americans will suffer back pain at some point in their lives, but despite plenty of diagnostic tools and treatment options available, it's one of medicine's most confounding problems.

April 04, 2011|By Karen Ravn, Special to the Los Angeles Times
  • Back pain is one of the most complicated problems in medicine, and it affects many patients.
Back pain is one of the most complicated problems in medicine, and it affects… (Photo illustration by Jack…)

Back pain — can't live with it, can't live without it.

That is, it's no fun to live with back pain, but the chances of living your whole life without it are pretty much nil. About 80% of Americans suffer from the condition at some point, so if you've never had your back act up or seize up or go out ... well ... just you wait.

This explains why, in the U.S., back pain is the second most-frequent reason to go to the doctor — right after the common cold. But here's the rub. In spite of all the knowledge and skill and experience and dedication your doctor may possess, not to mention all the high-tech diagnostic tools that can be brought to bear on your case, there's a good chance you'll never find out exactly what's wrong with your back.

"Back pain is one of the most complicated problems in medicine," says Dr. James Weinstein, professor of the evaluative clinical sciences and orthopedic surgery at Dartmouth Medical School. "It's something I've been working on for 30 years, and I still don't understand it."

The pain can run the gamut from irritating to excruciating. It can include sharp twinges, dull aches and even gasp-inducing spasms that surge like gigantic electric shocks. It can last anywhere from a day or two to years and years. It is said to be "chronic" if it lasts several months. Treatments abound, of course, but they might not help.

"For some of them, at least, the evidence that they work isn't that great," says Dr. Matthew Butters, chairman of the department of physical medicine and rehabilitation at the Mayo Clinic in Arizona. Many people can hope only to reduce the length of time spent in misery, not prevent or eliminate it completely.


More: Tribune Co. coverage on the best remedies for relief, finding the source of pain and upcoming therapies

"Most back pain resolves itself in six weeks, no matter what people do," he says. "We just try to facilitate recovery, to lessen that time."

Whether and when to see a doctor for back pain is generally a judgment call. (See related story.)

Dr. Michael Ferrante, director of the UCLA Pain Management Center and professor of clinical anesthesiology and medicine at the David Geffen School of Medicine at UCLA, suggests one rule of thumb: "If it's just a little ache or pain, take some Motrin. But if the idea crosses your mind that maybe you should see a doctor, then you probably should."

Once in a while, back pain warns you about something urgent — a tumor, cancer, kidney disease, etc. In fact, one of the main objectives for doctors is to rule out those types of problems, says Dr. Sean Mackey, chief of the pain management division at Stanford University. "And in the vast majority of cases, they do." But if they should happen to find a "sinister cause," it will be that condition they treat you for. Getting rid of your pain will merely be a fortuitous side effect.

Still, most of the time — perhaps as much as 98% — even if your back feels like it's killing you, you can rest assured that it's not. Getting rid of your pain is the main goal of treatment. In fact, some treatments ignore the underlying cause altogether. They're simply intended to eliminate, or at least ameliorate, the pain.

Clearly, this is an especially useful approach in cases in which the underlying cause is unknown — as it often is. Obvious suspects include ruptured or degenerative disks, spinal stenosis and arthritis, but matching the right one up with a particular patient's particular pain can be tricky — so tricky, in fact, that many surgeons and pain specialists say it's impossible 80% to 85% of the time.

It's excellent news, then, that doctors can often treat back pain even when they can't say exactly what's causing it.

Surgery

Surgery is the highest-profile treatment for back pain, and it should probably be used the least.

Dr. Richard Deyo, professor of family medicine and evidence-based medicine at Oregon Health and Science University, says it can be very effective for certain conditions: ruptured disks accompanied by sciatica (leg pain), spinal stenosis (narrowing of the spinal canal) and spondylolisthesis (slipping vertebrae).

But just because surgery works for these conditions doesn't mean it's the only treatment for them, or even the best. "You should exhaust all other options," says Dr. Alok Sharan, chief of spinal surgery at Montefiore Medical Center in the Bronx, N.Y., noting any operation's risk of complications. "Surgery should be your last option."

Most people with a ruptured disk will get better without surgery. Over time — maybe months or a year — the disk will shrink back. "Some people will put up with that, wait it out," Deyo notes. "But some people will say, 'I can't stand another day of this.' The advantage of surgery is that it's faster."

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