Course 101 In Back Pain
17 May 2004
Ask me about Economics 101 and I’ll flunk the question. But what about course 101 in back pain? In this case I have some answers. Ones that will help readers who ask "What is the best treatment for my aching back?"
Many years ago while in Hawaii I suddenly coughed and an excruciating pain shot down my leg. There was no doubt about the diagnosis, a ruptured spinal disk, and the pain was so severe I desperately needed a place to lie down.
Fortunately I was near an old historic church on a quiet back street. I walked in, in agony and stretched out on a not-so-comfortable wooden pew. But fate was not kind. Five minutes later a group of tourists entered and quickly diagnosed my problem. "My God" one said, "it’s only eleven in the morning and he’s already dead drunk!" I was in too much pain to argue.
The cure? Tincture of time and six weeks of not-so-pleasant living. But I knew that 95 per cent of ruptured disks recover in that time and it’s impossible to rush the healing. So I had to be what I often urge patients to be, "a patient patient". Moreover, I didn’t rush for X-rays.
If I had been in my home I would have placed a package of frozen peas on my back intermittently for 24 hours to decrease inflammation of the swollen disk. And later switched to heat compresses. This, along with Aspirin and other non-steroidal anti-inflammatory drugs, would make life a bit easier. But time, I knew, would be the great healer.
Some cases, however, require more than time. If there’s severe or progressive weakness in the leg, continuing numbness or tingling sensation, surgery may be indicated to remove a protruding disk before further injury occurs.
But how do you treat run-of-the-mill back pain? Some people are helped by the hands-on treatment of chiropractors, acupuncture and massage. Others are convinced that magnets and back belts are the answer.
But whatever way back pain is treated it’s prudent for patients to avoid needless radiation. A recent article in The New England Journal of Medicine charges that physicians order too many X-rays and MRI’s (magnetic resonance imaging) when trying to find the source of back pain. And many of these patients also end up with needless surgery.
X-rays of the back deliver 20 times the radiation received from X-rays of the chest or mammography. Remember as well that radiation isn’t there one day and gone the next. It accumulates in the body and lasts a lifetime.
There’s also a major enigma about the use of X-rays and MRIs to diagnose the cause of back pain. Time and time again pain has been shown to be an unreliable guide to what’s wrong in the back. For instance, an MRI may diagnose a ruptured disk, but the patient doesn’t have any pain! Other patients with excruciating pain have MRIs that show absolutely nothing.
The great problem for doctors is trying to convince patients who have pain day after day that there’s nothing seriously wrong with them. Invariably impatient, patients want X-rays and MRIs to pin-point the trouble and fix it.
So what is the most serious diagnosis? A red flag is raised if the patient has lost weight or has a fever. This might point to cancer or infection in the bone. But if these two symptoms are absent, the chance of these problems being present is nearly zero.
Another red flag flies if fracture is suspected. This is not normally a difficult diagnosis as there is often evidence of a blow or fall. But elderly patients can suffer fractures for unexplained reasons or if osteoporosis is present.
But it’s been estimated that these worst scenarios of back pain occur in only one in 30,000 cases. These are better odds than those at Los Vegas.
This is why it’s important not to push the panic button too soon when back pain strikes. Remember it’s such a common problem that it’s almost a part of normal living. So being a patient patient will not only save needless radiation but also save the health care system millions of dollars.
