"Get on with your normal life and ignore it until it goes away" does not seem like the most empathetic or therapeutic advice for a "healer" to provide to those struggling with serious back pain. And prescribing running or "exercise" is malpractice (though it is not as bad as prescribing a highly-addictive opioid). All exercises are not created equal. Back pain is muscle and nerve pain in some of the largest muscles in your body. Running does absolutely nothing for your back, except jiggle the muscles up and down and probably make them hurt more. Yoga and other "stretching" exercises also have very limited potential for improving serious muscle pain in such large muscle groups. A properly performed barbell or dumbbell squat weight training exercise will strengthen all the muscle groups surrounding the painful area as well as the muscles in the area itself, and is the most likely exercise to reduce or eliminate back pain. I must strongly emphasize "properly performed", because an improperly performed squat will create more injury. If you are experiencing serious lower back pain, do the research or work with a trainer until you know how to execute the exercise properly, then start doing a squat-based free weight (barbell or dumbbell, NOT weight machine) training program. Start with a light weight on three non-consecutive days a week, increase the weight slightly each workout until you are working with a moderately heavy weight, and your back pain will likely be gone in a month.
4
A nice 50/50 blend of THC/CBD works wonders for back pain. Cannabis is a serious therapeutic folks. If you don't like the buzz simply take CBD.
21
The cavalier attitude expressed in this article toward chronic back pain is gross and incredibly irresponsible.
Broken leg? What you need is a jump rope and ten interrupted hours of downward dog! Spondolysthesis, accompanied by multiple herniations, radiating leg and calf pain and numbness in adjacent areas? Wait, AND a general inability to stand, walk or sleep due to a disc that is in near constant contact with the bundle of nerves governing said lame, unmanly limb? Two words: ultra and marathon.
There is literally nothing aside from surgery that I haven't done in an attempt to alleviate or eliminate my chronic back pain (caused by a condition similar to the one I describe.) This includes: "doing what I always do," running, yoga, Pilates/daily core work (still do), PT, acupuncture, mindfulness meditation (have since I was 19), injections, doing whatever I want... The list is endless. Short of spending half my life supine, and the rest stretching, going on slow walks, meditating, doing core work, not having sex, etc., I need opiates and muscle relaxers in order to function.
These "guidelines" are NOT for people with genuine, incapacitating injuries. Or, if they are, the people who wrote them are severely misguided.
Broken leg? What you need is a jump rope and ten interrupted hours of downward dog! Spondolysthesis, accompanied by multiple herniations, radiating leg and calf pain and numbness in adjacent areas? Wait, AND a general inability to stand, walk or sleep due to a disc that is in near constant contact with the bundle of nerves governing said lame, unmanly limb? Two words: ultra and marathon.
There is literally nothing aside from surgery that I haven't done in an attempt to alleviate or eliminate my chronic back pain (caused by a condition similar to the one I describe.) This includes: "doing what I always do," running, yoga, Pilates/daily core work (still do), PT, acupuncture, mindfulness meditation (have since I was 19), injections, doing whatever I want... The list is endless. Short of spending half my life supine, and the rest stretching, going on slow walks, meditating, doing core work, not having sex, etc., I need opiates and muscle relaxers in order to function.
These "guidelines" are NOT for people with genuine, incapacitating injuries. Or, if they are, the people who wrote them are severely misguided.
41
I suffer from a hereditary connective tissue disorder called Ehlers-Danlos syndrome, and I am a chronic pain patient, with the pain usually at its worst in my back. I have to say that I am appalled by this article.
This has got to be one of the most egregious examples of single-cause fallacy that I have seen recently. There is no such thing as "back pain". That's a blanket term. What we call back pain may be the result of anything from muscle spasms to disc degeneration to compression fractures (and my condition increases the risk of all of these things). Failure to prescribe even the mildest pain medications to a responsible patient with no history of substance abuse is inhumane, but somewhat predictable given our current moral panic over opioids; failure to do anything at all, even write for an MRI, is not only inhumane but also lazy and irresponsible.
Many of the other readers on this thread note that the doctors quoted in this article have probably never experienced real back pain. I must concur. Perhaps one day they will be in the shoes of the patients. (Ever see "The Doctor" with William Hurt? If you're in the medical profession and you're reading this, you ought to, if for no other reason than to hone your sense of empathy.)
This has got to be one of the most egregious examples of single-cause fallacy that I have seen recently. There is no such thing as "back pain". That's a blanket term. What we call back pain may be the result of anything from muscle spasms to disc degeneration to compression fractures (and my condition increases the risk of all of these things). Failure to prescribe even the mildest pain medications to a responsible patient with no history of substance abuse is inhumane, but somewhat predictable given our current moral panic over opioids; failure to do anything at all, even write for an MRI, is not only inhumane but also lazy and irresponsible.
Many of the other readers on this thread note that the doctors quoted in this article have probably never experienced real back pain. I must concur. Perhaps one day they will be in the shoes of the patients. (Ever see "The Doctor" with William Hurt? If you're in the medical profession and you're reading this, you ought to, if for no other reason than to hone your sense of empathy.)
57
I have chronic back pain since 2011. It got even worse after the surgery (L5-S1 level herniated disc). I was only on NSAIDs at that time. Of course, with PT, acupuncture, TENS, etc - I tried them all - none worked! After 2 years of pain, my doctor finally prescribed me morphine and a muscle relaxant as an adjuvant. I have been on the combo for 2 years - pain is manageable, its still there, but at least I can function and work. Now the hospital where I go to is switching their method on low back pain. My new doctor is now trying to taper off my morphine and Soma. This is crazy! Just because some people abuse morphine, now I have to suffer from my back pain again?! I am aware that I am gonna be taking these 2 medicines for life - and I have no problem with it as long as it gives me some pain relief from my back pain. When people hear this, they think "addiction". Would you call a person taking his/her Lipitor everyday for the rest of their life an addict too? The medical arena needs to know that addiction => abusing controlled drug from what it is prescribed for in order to get the "hi". I am taking these medicine to function at my work and home - not to get hi!
Morphine and its adjuvant can really help patients with chronic back pain rather than using NSAIDs. Of course, if non medicine can work, that'd be better. Otherwise, the use of morphine + adjuvant can break the pain for your patients.
Morphine and its adjuvant can really help patients with chronic back pain rather than using NSAIDs. Of course, if non medicine can work, that'd be better. Otherwise, the use of morphine + adjuvant can break the pain for your patients.
37
I had lower back pain for years which could be triggered by pretty much any activity.
What worked was being diagnosed with GERD and adopting a low acid diet.
The result was almost instant. Within days, I not only had a cessation of back pain, but also a background 'all body' ache, especially my hands.
I still stiffen up in cold, wet weather, but I'm pain free. As a result I can get in & out of chairs & bed easily, get out more, started a balcony garden which means moving soil etc upstairs, & have been able to resume hand intensive hobbies.
The extra movement - just walking a lot - resulted in some weight loss - about 2 sizes.
I'm still very careful when it comes to anything that could strain my back - the potting mix comes up a few kilos at a time - but on the whole I went from moving like 80+ back to my real age in the 60s.
That said, any chronic pain can have other implications & people should insist on a diagnosis. Doctors get it wrong around 30% of the time.
What worked was being diagnosed with GERD and adopting a low acid diet.
The result was almost instant. Within days, I not only had a cessation of back pain, but also a background 'all body' ache, especially my hands.
I still stiffen up in cold, wet weather, but I'm pain free. As a result I can get in & out of chairs & bed easily, get out more, started a balcony garden which means moving soil etc upstairs, & have been able to resume hand intensive hobbies.
The extra movement - just walking a lot - resulted in some weight loss - about 2 sizes.
I'm still very careful when it comes to anything that could strain my back - the potting mix comes up a few kilos at a time - but on the whole I went from moving like 80+ back to my real age in the 60s.
That said, any chronic pain can have other implications & people should insist on a diagnosis. Doctors get it wrong around 30% of the time.
11
Not one explanation of why a person would experience back pain that will go away within twelve weeks. Do these physicians have a clue or are we getting one of these "melancholy causes tuberculosis" stories?
24
Quite frankly, my biggest fear after reading this article is that it is one more attempt by the new order to brainwash us into ignoring our bodies while we work until we drop.
Could it be that back pain is one way our body is telling us to take a break from the insanity that is now the workplaces and we ignore it at our peril?
Could it be that back pain is one way our body is telling us to take a break from the insanity that is now the workplaces and we ignore it at our peril?
38
I had lower back tightness for well over a decade, mainly across the top of the glutes on the right side. Used to stiffen up on long walks or standing for a long time. Tried absolutely every possible treatment $$& known to humankind. Brief hope, but no cigar.
Ended up the simple miracle cure was water. Tested it out extensively on myself over months and it's conclusive; when I'm properly hydrated I have zero problems. The cure is free. When I'm low on water it starts to slowly return.
Go sit in a sauna (in and out) for an hour or more. Lose a ton of sweat. See if you've got stiffness or your back is sore the next day.
It might not be the problem for everyone but if this advice helps one person be pain free I have done my good deed for the day! The body needs ample water and most people I think are chronically dehydrated.
My other tangential health tip for those feeling off colour for weeks and low on energy... probiotics... as your first port of call.
Good health everyone!
Ended up the simple miracle cure was water. Tested it out extensively on myself over months and it's conclusive; when I'm properly hydrated I have zero problems. The cure is free. When I'm low on water it starts to slowly return.
Go sit in a sauna (in and out) for an hour or more. Lose a ton of sweat. See if you've got stiffness or your back is sore the next day.
It might not be the problem for everyone but if this advice helps one person be pain free I have done my good deed for the day! The body needs ample water and most people I think are chronically dehydrated.
My other tangential health tip for those feeling off colour for weeks and low on energy... probiotics... as your first port of call.
Good health everyone!
25
That's really nice to wait out agonising pain, but not all of us have the leisure to put life on hold for the six months or more that a doctor requires before believing that something is wrong. We have to get up and complete our often physical work of living life. If we need some pain control over the short term to accomplish that, it shouldn't be forbidden. Another person's choice to abuse medication should not obligate me to suffer pain to satisfy the DEA or AMA.
14
Good luck on this. People want the easy way out and that is a pill. I think it would also be helpful if physicians talked a lot more about proper nutrition and weight.
5
I agree with this for someone who has an acute issue. I have suffered through years of back pain where a disc wore away completely (you don't want to know from that pain) and the cure was worse, I have mild drop foot and an overgrown bone pinching a nerve. No cure. Physical therapy helps slightly, weight loss helped more, but it will never, ever go away and there are times where you need opiates to function. I live in fear of a world where they will swing the pendulum the other way and it will be impossible to get relief even going through the amazing monthly hoops I go through to renew my meds.
10
Some of us are already without meds. It's a nightmare caused by ill-informed busybodies.
I lived and worked for 25 years with constant, intense pain before I gave in and took narcotics. If that offends people who have never lived with such pain, bite me. Maybe you should live with constant pain for a decade or so before you judge those of us with intractable pain.
I lived and worked for 25 years with constant, intense pain before I gave in and took narcotics. If that offends people who have never lived with such pain, bite me. Maybe you should live with constant pain for a decade or so before you judge those of us with intractable pain.
13
I'm someone who: a) is very active physically; b) has suffered from lower back pain in the past; c) has never taken anything stronger than Ibuprofen for the pain. I can say that the advice reported on here is both spot on and long overdue. However, one must NOT be too active when the pain is there. Don't work out or do anything much beyond walking when your back hurts. When there's pain you require rest, heat (and possibly ice to counteract the inflammation heat may cause), and perhaps an occasional dose of two Ibuprofen. When pain-free you should indeed stretch, do yoga, and exercise.
My back pain was caused mainly by weight lifting -- or at least when I cut back some on the weights the pain, which had threatened to become chronic, largely disappeared. I still lift (but not as intensely) and do plenty of aerobic work, but I'm basically pain-free. When I did have pain it could be severe and borderline incapacitating, but rest, heat, and the occasional Ibuprofen allowed me to function normally. Opioids aren't called for, IMO. But do make sure to REST when you have pain. Pain is often your body telling you that it needs to rest and recover.
My back pain was caused mainly by weight lifting -- or at least when I cut back some on the weights the pain, which had threatened to become chronic, largely disappeared. I still lift (but not as intensely) and do plenty of aerobic work, but I'm basically pain-free. When I did have pain it could be severe and borderline incapacitating, but rest, heat, and the occasional Ibuprofen allowed me to function normally. Opioids aren't called for, IMO. But do make sure to REST when you have pain. Pain is often your body telling you that it needs to rest and recover.
6
Dr. John Sarno, who wrote "Healing Back Pain", has been saying for decades for those with back pain to ignore the symptoms and get on with their lives, that many symptoms are psycosomatic. His book ended yesrs of on-again, on-again back pain for me.
11
I appreciate this article ... and I do understand the feelings of all those who are commenting about their own pain. Yes, doctors do need to take more time to listen and educate. Yes, imaging studies are important if symptoms do not improve as expected, or if there are neurologic symptoms ... or if there is pain that is pronounced even at night while laying still. But there are numerous studies in children (who don't tend to superimpose anxiety or expectations on their treatments) showing that ibuprofen is SUPERIOR to opiates in controlling their pain. There is a strong component to what you BELIEVE will help you, as all those placebo studies show.
One thing that was not mentioned is the TENS unit... (Transcutaneous Electric Nerve Stimulator)...I have chronic low back issues and I have found that my TENS unit, along with local heat and gentle but frequent range of motion exercises, beats ANY pill for working back out of the pain. The TENS unit has no side effects, is cheap ($30-40 on Amazon), is safe even for pregnant women and can be adjusted in intensity and frequency to suit individual needs and differences in pain through the day. No brain fog or addiction. I get them as gifts for all my friends who have chronic pain and they love them too!
One thing that was not mentioned is the TENS unit... (Transcutaneous Electric Nerve Stimulator)...I have chronic low back issues and I have found that my TENS unit, along with local heat and gentle but frequent range of motion exercises, beats ANY pill for working back out of the pain. The TENS unit has no side effects, is cheap ($30-40 on Amazon), is safe even for pregnant women and can be adjusted in intensity and frequency to suit individual needs and differences in pain through the day. No brain fog or addiction. I get them as gifts for all my friends who have chronic pain and they love them too!
3
I tried a TENS unit. It was an irritation but ineffective on pain. Ibuprofen and other NSAIDs? They ease the pain for about 18 hours, then tear through my lower GI tract so I'm doubled over with cramps sitting on the throne. That's not an improvement.
There are, unfortunately, chronic conditions that cause intense pain. The pain is very real. It doesn't respond to anything but narcotics. Get over it. If your body or psyche cannot handle narcotic analgesics, don't take any. Don't make ill-informed decisions for the rest of us. We have the government doing that already.
There are, unfortunately, chronic conditions that cause intense pain. The pain is very real. It doesn't respond to anything but narcotics. Get over it. If your body or psyche cannot handle narcotic analgesics, don't take any. Don't make ill-informed decisions for the rest of us. We have the government doing that already.
8
Whenever there is talk of back pain, I can't help myself but to share my story. I had chronic back pain for 9 years. I had MRIs, CAT scans and xrays, but no doctor could tell me what the problem was. Then I went to my family physician as I had a new pain near my appendix. She said she thought it was my ileocecal valve. After researching more about it, I found a wonderful chiropractor on-line who was all about the ileocecal valve and its mimicking of back pain, heart problems, and other chronic diseases. After teaching me a simple massage technique whereby massaging the valve 3 times a day, after the first day my back pain was GONE. Every now and then I still need to massage it, but I no longer have any pain and have a whole new life to live. The chiropractor's name is Dr. John Pollard III out of Sacramento. He will tell you the ileocecal causes so much disruption from being irritated by not so much as what we eat, but how we eat. Chew your food 40 times and your problem should go away. I'm forever grateful to Dr. Pollard and my family physician. I often wonder how many other people have the potential to a simple remedy to save them from chronic pain but they just don't know about it.
5
I have been a member of AA for 5 years, therefore I have heard countless stories of opioiod use and abuse. As a person who's drug of choice was alcohol, I never had my own struggles with opioids, but I am continuously blown away by how many of my fellow AA's journey's began with back pain and a Vicodin script, and ended with that complete demoralization that lands us in church basements.
In sobriety, I've herniated a disc twice. The second time I had insurance, so I went to the doctor. I was disturbed by her immediate offer of an opiate and a heavy muscle relaxer (which I declined). It's not that I'm unaware that these medications are helpful, it's that I'm more acutely aware of the harm they can and have caused many unsuspecting patients. People don't typically know that they are an addict until they are. Pain is bad, but addiction is worse - I promise.
It has been four months since my most recent injury, and I have been living with such chronic pain that it has left me spending most of my non-working hours lying down, yet I found this article to be encouraging. Since opiate are not and will never be an option for me, it reminds me that there is something that I can do. You certainly won't find me running tomorrow, but I think it's time I get out of bed and start taking some more physical action so that "life can get better".
In sobriety, I've herniated a disc twice. The second time I had insurance, so I went to the doctor. I was disturbed by her immediate offer of an opiate and a heavy muscle relaxer (which I declined). It's not that I'm unaware that these medications are helpful, it's that I'm more acutely aware of the harm they can and have caused many unsuspecting patients. People don't typically know that they are an addict until they are. Pain is bad, but addiction is worse - I promise.
It has been four months since my most recent injury, and I have been living with such chronic pain that it has left me spending most of my non-working hours lying down, yet I found this article to be encouraging. Since opiate are not and will never be an option for me, it reminds me that there is something that I can do. You certainly won't find me running tomorrow, but I think it's time I get out of bed and start taking some more physical action so that "life can get better".
16
"Pain is seldom believed by those in whom it's not felt" (anon)
I recall reading a study in which a group of radiologists rated 100 back X-rays with equal amounts of degenerative pathology. The patients with those X-rays were then asked what type of back problems they had. 20 of them said we don't have any back problems. 20 of them were disabled from back pain. And the rest had varying degrees of discomfort from minimal to severe pain.
Pain, especially back pain is one of the most complex medical conditions to treat and diagnose. It is also amongst the most common reason why people seek attention at their primary care physicians office. This is obviously one of the most "One size fits all" diagnoses that cannot be applied.
While Western medicine seeks to diagnose and compartmentalize health conditions and disease for the sake of efficiency and cost containment , human beings are messy. They simply do not fit frequently into simple little boxes.
There is no simple answer to this and other medical dilemmas. However when physicians are given enough time and support to thoroughly assess the situation the best outcome can often be achieved.
I encourage you to read an op-ed I wrote about one aspect of this situation: www.seattletimes.com/opinion/caring-small-practice-doctors-becoming-enda...
I recall reading a study in which a group of radiologists rated 100 back X-rays with equal amounts of degenerative pathology. The patients with those X-rays were then asked what type of back problems they had. 20 of them said we don't have any back problems. 20 of them were disabled from back pain. And the rest had varying degrees of discomfort from minimal to severe pain.
Pain, especially back pain is one of the most complex medical conditions to treat and diagnose. It is also amongst the most common reason why people seek attention at their primary care physicians office. This is obviously one of the most "One size fits all" diagnoses that cannot be applied.
While Western medicine seeks to diagnose and compartmentalize health conditions and disease for the sake of efficiency and cost containment , human beings are messy. They simply do not fit frequently into simple little boxes.
There is no simple answer to this and other medical dilemmas. However when physicians are given enough time and support to thoroughly assess the situation the best outcome can often be achieved.
I encourage you to read an op-ed I wrote about one aspect of this situation: www.seattletimes.com/opinion/caring-small-practice-doctors-becoming-enda...
9
As an R.N. who had a lamenectomy, and who suffers from chronic back pain intermittently, I am so thankful that my Dr. gave me this same advise 35 years ago. Aspirin is my miracle drug..... nothing else works... only Aspirin. When my back goes out. His advise: Take 2,000mg of ASA non-enteric coated immediately for back pain, followed by 1200mg every 6-8 hours. Do not exceed 4000mg in a 24 hour period. This advise has served me well and has prevented me from becoming addicted. I have found, my pain returns when I STOP exercising. I also am a fan of an electric heating pad.
I would not take an Opioid if my life depended upon it. Those that strongly defend "their" need for Opioids are , frankly, addicted and are in denial.
I would not take an Opioid if my life depended upon it. Those that strongly defend "their" need for Opioids are , frankly, addicted and are in denial.
16
Try ice/ frozen gel pack in addition to heating pad. I find that icing really helps with being pain free for many hours, while heating pad provides more immediate relief. The theory is that icing help local blood circulation as the body tries to regulate temperature and that somehow helps.
4
I have suffered chronic back pain for years. I travelled the country to find a diagnosis. when I finally got my diagnosis no one at my HMO said they had any idea what it was. I had documents from a well known doctor that stated in my particular case surgery was warranted. I tried every homeopathic remedy and yoga, pt and I wound up in more pain. I would not be able to function without pain medication. luckily I have never taken more than allowed and not become addicted. Dependent yes but so many doctors don't understand the difference between addiction and dependent. It' my body and I'd rather live and be able to dress myself and live a shorter life. As I had cancer I know what having my life possibly end is about. What I really think is the problem is that doctors are frustrated and don't really have the answers yet to chronic pain. Chronic pain is a misfire of brain signals. It's no one's fault and an injury can be healed and yet excruciating pain persists. Until we understand chronic pain and how the brain works we are stuck. On the one hand patients in pain are told to not take pills and then the big pharma companies are dropping off free samples to doctors offices. Doctors need to have more compassion for those in pain and deal with their frustrations of not having their patients improve according to schedule. Would we not have the problem of opiate addiction if the big pharma companies didn't push drugs? Walk a mile in my shoes or in my case pajamas.
10
I had a disc ruptured - in fact compressed to the point of explosion - in an accident. It required three surgeries over two years to fix insofar as a fix was possible. The final surgery was a five-hour procedure that gave me a prosthetic disc and fairly severe surgical wounds on my back and front. Two of the surgeries required a few weeks of recovery and the third required months. I was prescribed two types of opioids and I used barely any of them but I was very glad of them when needed. I had no symptoms of addiction or anything approaching dependency - I am still taking the odd pill from the original prescription about once every three months. I challenge anyone to get through either the pain of recovery or the worst of the post-accident or chronic pain without something more than non-prescription drugs. Exercise is vital. Muscle relaxants are probably under prescribed. Time and rest are vital and in too short supply because employers and the US system don't allow for them. I was incredibly fortunate that my insurer yielded and allowed me the efficacious prosthetic instead of the more common and cheaper, but more painful and debilitating fusion. That all being the case, one cannot refuse a proper combination of serious analgesics and monitoring by healthcare professionals. Forcing people to suffer pain unnecessarily is barbaric.
29
Low back pain continues to be a difficult issue for medical practitioners. However, the past practice of prescribing opiates and MRI's has not resulted in a "fix". Yes, sometimes MRI's are needed: when the RESULT will CHANGE the treatment, but not to simply make a diagnosis. And yes, sometimes a person needs surgery, but mostly this is NOT the case. Multiple studies prove that if you see a physical therapist first, you will stand the best chance of reducing the cost of care, and reduce the utilization of health care resources over time. Physical therapists should be able to identify the red flags that indicate a person has more serious pathology, and refer them on to an appropriate practitioner when something more then rehab is needed. But most of the time, a PT will help you identify poor mechanics that contribute to the pain, reassure the person as to what movement is good and which is best to avoid, and exercises to do to help the situation currently and IN THE FUTURE. Studies show that the brain has a large impact on how a person perceives their pain (NOT faking it, by the way), and that reassurances and education can calm the brain down and help a person move forward. So it is not a "drugs" or "just walk it off" alternative. Seek the advice of a health care professional who will help you actively navigate your situation, with as little aggressive intervention as possible. http://www.apta.org/Media/Releases/Consumer/2015/4/9/
15
What? MRIs do not treat anything. An MRI is a diagnostic scan by definition.
4
I suffer from lower back pain regularly. I have a small and simple device, called twin stim. I place two or more electro pads on where it hurts and after a few treatments the pain is gone. It numbs the pain, so I will not get stiff in that area.
4
Back pain is the result of back muscles that the brain forgot how to let go of, fully. The sensory motor system that controls muscles is stuck on auto-pilot. This occurs due to habituation to repetitive stress (lifting, hauling, standing all day, meeting deadline, slumping at computers), accidents, injuries, surgeries or mental stress. The muscles learn to stay tight, so the brain must teach the muscles to stay tight. Fast movement can't do that; it must be slow, gentle, aware movement that addresses the whole system. That's how the brain learns: slowly, through habituation.
Hanna Somatic Educators teach people get rid of back pain (and hip, neck, shoulder, knee pain) every day. Hanna Somatics - the very definition of non-invasive - is a sensory motor movement-based method - teaches the person in pain how to literally turn off these habitually contracted and painful muscles. John Sarno's work can serve as a wonderful complement.
Medicine and manipulative therapies try to fix the problem from the OUTSIDE, as if the sufferer were a broken car. The fact is, in most cases, the problem is on the INSIDE and can only be "fixed" by the person suffering the pain. When they learn to re-train their internal ability to sense and control their own muscles in a gentle, slow way, full muscle length and function returns, movement is more easeful, and the pain goes away. Read my book, Move Without Pain. It will help.
Hanna Somatic Educators teach people get rid of back pain (and hip, neck, shoulder, knee pain) every day. Hanna Somatics - the very definition of non-invasive - is a sensory motor movement-based method - teaches the person in pain how to literally turn off these habitually contracted and painful muscles. John Sarno's work can serve as a wonderful complement.
Medicine and manipulative therapies try to fix the problem from the OUTSIDE, as if the sufferer were a broken car. The fact is, in most cases, the problem is on the INSIDE and can only be "fixed" by the person suffering the pain. When they learn to re-train their internal ability to sense and control their own muscles in a gentle, slow way, full muscle length and function returns, movement is more easeful, and the pain goes away. Read my book, Move Without Pain. It will help.
13
This is consistent with the experiences I've described in my own comments.
2
Some back pain is the result of spinal damage. Muscles can spasm as a result of spine problems, but there are no magic exercises to heal damaged bones. When I was in school, the tall guys would stand on a bench, pick me up under my arms, and "crack" my spine to ease the pain. Each vertebrae pop as my back stopped bearing weight. That worked well for a few years, but the damage is too severe now.
I've tried time, yoga, PT including traction, those silly electronic pads than cause an annoying sensation but no pain relief, acupuncture, and countless other things. No joy.
If I take morphine round the clock, I can lead a seminormal life, but since the feds got paranoid about narcotics, I'm bedridden. I see that junkies are still ODing at alarming rates. People in severe pain never share or sell their medications, but we're being punished for the misbehavior of others.
Don't tell me how to treat the bone and nerve damage in my spine. It's not muscle pain. The original injury was in 1984, but the scoliosis was around long before that. I have RA to add to the fun.
Surgery? It has a 5% success rate as far as reducing pain. My orthopedist was appalled that another doctor had demanded I have back surgery. He had no idea what the guy was going to "fix."
So thanks to the FDA, CDC, and DEA, I'm bedridden. I wish each of those folks a long life of intractable pain. I'm not a sissy about pain. I don't notice kidney stones passing unless there's lots of blood. I ignore migraines.
I've tried time, yoga, PT including traction, those silly electronic pads than cause an annoying sensation but no pain relief, acupuncture, and countless other things. No joy.
If I take morphine round the clock, I can lead a seminormal life, but since the feds got paranoid about narcotics, I'm bedridden. I see that junkies are still ODing at alarming rates. People in severe pain never share or sell their medications, but we're being punished for the misbehavior of others.
Don't tell me how to treat the bone and nerve damage in my spine. It's not muscle pain. The original injury was in 1984, but the scoliosis was around long before that. I have RA to add to the fun.
Surgery? It has a 5% success rate as far as reducing pain. My orthopedist was appalled that another doctor had demanded I have back surgery. He had no idea what the guy was going to "fix."
So thanks to the FDA, CDC, and DEA, I'm bedridden. I wish each of those folks a long life of intractable pain. I'm not a sissy about pain. I don't notice kidney stones passing unless there's lots of blood. I ignore migraines.
21
I used to have back pain all the time. And neck pain.
Then I got divorced.
No problems for the last six years.
Reduce your stress, reduce your pain.
It can be difficult to admit what the true sources of your problems are.
Then I got divorced.
No problems for the last six years.
Reduce your stress, reduce your pain.
It can be difficult to admit what the true sources of your problems are.
27
Maybe it was the lightening of your wallet that relieved your pain.
13
An opioid should never be given unless there's been some sort of imaging that shows a break or a fracture. And then the number of opioids prescribed should be in the single digits.
For most other lower back problems, it's been proven that opioids are not going to help. If a person thinks opioids are helping to control their pain, the person is wrong and likely addicted. There's no easy way out of that; to break the addiction, the person is going to have to suffer withdrawal which will disguise itself as worse pain.
Based on an MRI, my doctor diagnosed me with degenerative disc disease. He prescribed gentle exercises, a change in shoes, an as-needed back brace, and Advil. No more running, but I can do anything else. The pain has all but disappeared--without opioids or surgery.
For most other lower back problems, it's been proven that opioids are not going to help. If a person thinks opioids are helping to control their pain, the person is wrong and likely addicted. There's no easy way out of that; to break the addiction, the person is going to have to suffer withdrawal which will disguise itself as worse pain.
Based on an MRI, my doctor diagnosed me with degenerative disc disease. He prescribed gentle exercises, a change in shoes, an as-needed back brace, and Advil. No more running, but I can do anything else. The pain has all but disappeared--without opioids or surgery.
8
"If a person thinks opioids are helping to control their pain, the person is wrong and likely addicted." Good Lord. So anyone who produces evidence, anecdotal or otherwise, that contradicts your claims is a self-deluded addict? Way to dismiss opposing views by poisoning the well. How do you know what other people are or are not feeling and exactly what is going on in their bodies? There are seven billion people on this planet; surely there are some standard deviants somewhere. Sweeping generalizations are dangerous.
12
You don't have a clue.
12
I never thought I would say this but I hope Dr. Rick Deyo comes down with back pain.
I hope is so severe that he cannot turn over in bed without severe pain, cannot get on or off the toilet without severe pain and ends up in the emergency room with blood pressure above 200 because of the pain. All this happened to me. Relief came when the ER Dr. gave me several morphine drips and a heavy dose of hydrocodone. The ER Dr’s comment was that you can never get better when you are in severe pain. I took the hydrocodone in decreasing dosage for two weeks then began physical therapy (which was a subset of the exercises I had been doing in the gym for the previous fifteen years).
I hope, when Dr. Deyo gets to the ER, the Dr. tells him to suck it up and go jogging. In this case I think there may be a second edition of his recommendations.
I hope is so severe that he cannot turn over in bed without severe pain, cannot get on or off the toilet without severe pain and ends up in the emergency room with blood pressure above 200 because of the pain. All this happened to me. Relief came when the ER Dr. gave me several morphine drips and a heavy dose of hydrocodone. The ER Dr’s comment was that you can never get better when you are in severe pain. I took the hydrocodone in decreasing dosage for two weeks then began physical therapy (which was a subset of the exercises I had been doing in the gym for the previous fifteen years).
I hope, when Dr. Deyo gets to the ER, the Dr. tells him to suck it up and go jogging. In this case I think there may be a second edition of his recommendations.
58
I've wrenched my back so badly I couldn't even contemplate getting into a vehicle to get to the ER (unrelated to my degenerated disc). I could crawl, barely, to the bathroom. Almost as bad as the back pain was the realization that I might need to go the adult-diaper route.
Both times it resolved on its own after 3-4 painful days, without opioids. Or adult diapers, thank goodness.
I don't see the need for anyone to gut it out like that (I was forced to because I could not physically get into a car to get medical help), but 2 weeks of hydrocodone seems excessive and reckless on the part of the doctor. You would have eventually gotten better without risking opioid addiction.
Both times it resolved on its own after 3-4 painful days, without opioids. Or adult diapers, thank goodness.
I don't see the need for anyone to gut it out like that (I was forced to because I could not physically get into a car to get medical help), but 2 weeks of hydrocodone seems excessive and reckless on the part of the doctor. You would have eventually gotten better without risking opioid addiction.
3
Amen!!! that and legal cannabis.
6
Long, but lots of good data. Read especially the section on Opioids, where they found NO systematic reviews of their use and only one study that showed them to be more effective than placebo. http://annals.org/aim/article/736857/medications-acute-chronic-low-back-...
1
It's great article! In pass 16 years I had 3 MVAs and suffering from chronic neck pain and lower back pain. MRI diagnosed with C3,4, C5,6 , L1-S1 multiple disks herniation. Using Acupuncture, massage therapy, physical therapy, chiropractic treatments and exercises like tai chi, qigong and yoga able to manage my pain without any medications!
As a medical doctor in China and Acupunctureist in US for almost 20 years, I have treated thousands of patients with lower back pain with Acupuncture, some patients have been used heavy medications or /and injections still having pain, Acupuncture or combine with other therapies able to relief the pain and gradually withdraw the pain killers. Patients came in walking with the walkers and able to walk normally after several treatments.
For whom suffering from pain, please consider these therapies before you jump into painkillers and muscle relaxers, avoid side effects of GI upset, liver/kidney damage! And definitely don't want to devolpe addiction to drugs!
As a medical doctor in China and Acupunctureist in US for almost 20 years, I have treated thousands of patients with lower back pain with Acupuncture, some patients have been used heavy medications or /and injections still having pain, Acupuncture or combine with other therapies able to relief the pain and gradually withdraw the pain killers. Patients came in walking with the walkers and able to walk normally after several treatments.
For whom suffering from pain, please consider these therapies before you jump into painkillers and muscle relaxers, avoid side effects of GI upset, liver/kidney damage! And definitely don't want to devolpe addiction to drugs!
4
Most of us have tried everything before going to narcotics. Sometimes there's just too much damage.
I no longer carry things that outweigh me, because I can't. If something needs to be moved, most of us pick it up and carry it. I don't think that damaged my back. I can no longer carry more than about 20 pounds.
No matter the cause, the pain is real. Most of us have tried all kinds of absurd "treatments" without success. You know how you feel. I know how I feel. Don't confuse the two.
I no longer carry things that outweigh me, because I can't. If something needs to be moved, most of us pick it up and carry it. I don't think that damaged my back. I can no longer carry more than about 20 pounds.
No matter the cause, the pain is real. Most of us have tried all kinds of absurd "treatments" without success. You know how you feel. I know how I feel. Don't confuse the two.
9
What this article fails to mention is what therapy actually does work. If you have back, shoulder, sciatica, or fibromyalgia, please check out "Healing Back Pain" by Dr John Sarno. It explains everything in a much more complete manner and worked like a miracle for me and a bunch of other people I bow know. Good luck!!!
4
As others on this thread have mentioned, check out "Healing Back Pain" by Dr John Sarno and you'll understand why these current approaches dont work, and something that does. Its a miracle.
5
There is excellent evidence for the utility of interventional pain procedures when performed on the correct patient for the correct condition. However, why bother!? That severe herniated disc pain will get better on its own in 6 months. Just walk it off.
That severe back pain for 3 months? Why get a diagnosis with safe technology like an MRI? Nah, Just pretend it's muscle pain. I'm sure the patient won't sue if it ends up being a tumor.
Btw - yoga, chiro, and acupuncture have garbage for evidence...
That severe back pain for 3 months? Why get a diagnosis with safe technology like an MRI? Nah, Just pretend it's muscle pain. I'm sure the patient won't sue if it ends up being a tumor.
Btw - yoga, chiro, and acupuncture have garbage for evidence...
10
As others have mentioned on this thread, check out "Healing Back Pain," by Dr John Sarno.
3
MRI's as evidence?
Look at the study from the 90's where they *finally* took MRI's of non-sufferers and discovered that they, too, were walking around with herniated discs. I mentioned this to my crusty old former Army neurosurgeon and he agreed, saying that in the 60's, prior to MRI technology, they would take a myelogram of patient's full spine in prep for CERVICAL disc surgery and they would often see lumbar herniations even though the patient had no low back pain.
My --and others'-- experience is that if you go to an orthopedist or neurologist with back pain they will find something to attribute it to, usually herniated discs on an MRI. Dr. Sarno explains why a herniated disc doesn't explain our symptoms. After 25 years of chronic and acute pain, I've been pain free for most of the last 12 years.
Look at the study from the 90's where they *finally* took MRI's of non-sufferers and discovered that they, too, were walking around with herniated discs. I mentioned this to my crusty old former Army neurosurgeon and he agreed, saying that in the 60's, prior to MRI technology, they would take a myelogram of patient's full spine in prep for CERVICAL disc surgery and they would often see lumbar herniations even though the patient had no low back pain.
My --and others'-- experience is that if you go to an orthopedist or neurologist with back pain they will find something to attribute it to, usually herniated discs on an MRI. Dr. Sarno explains why a herniated disc doesn't explain our symptoms. After 25 years of chronic and acute pain, I've been pain free for most of the last 12 years.
"I'm sure the patient won't sue if it ends up being a tumor." You brought back painful memories of my beloved father. In his fifties, he was out mowing the lawn when he came down with excruciating, intractable pain in his lower back. He was a doctor himself, and somewhat stoic about his own pain. He did not like to consider the possibility of his being sick or injured most of the time. He refused to take any medications for the pain, and did not tell my mother about it for a while. Eventually he went to see a fellow doctor to get at the root cause.
The root cause wasn't a herniated disc. The root cause wasn't a muscle spasm. The root cause wasn't arthritis or postural defects or the wear and tear of aging. The root cause was prostate cancer.
He is no longer with us.
How many families will suffer the same fate if a loved one is told to "just wait it out" and not even given diagnostic imaging?
The root cause wasn't a herniated disc. The root cause wasn't a muscle spasm. The root cause wasn't arthritis or postural defects or the wear and tear of aging. The root cause was prostate cancer.
He is no longer with us.
How many families will suffer the same fate if a loved one is told to "just wait it out" and not even given diagnostic imaging?
6
YOU trying being active if every little move causes agonizing pain.
YOU try PT when it hurts so much you can't even start.
Does this mean lie around and do nothing? Of course not.
Don't be afraid to take any painkillers you need so you CAN move. Then, slowly, begin activities and PT.
This makes everyone who is in too much pain to move feel guilty.
Take whatever meds you need and work at your own pace.
As soon as the pain recedes, taper off gradually.
YOU try PT when it hurts so much you can't even start.
Does this mean lie around and do nothing? Of course not.
Don't be afraid to take any painkillers you need so you CAN move. Then, slowly, begin activities and PT.
This makes everyone who is in too much pain to move feel guilty.
Take whatever meds you need and work at your own pace.
As soon as the pain recedes, taper off gradually.
27
Thanks for posting. Please read any of works by Drs John Sarno or Savod Hanscom. Good luck.
2
Obviously this was written by someone who doesn't have any pain!
19
Check out Dr John Sarno's "Healing Back Pain." Good luck!
1
It's nothing, except when it's something like a herniated disc or arthritis of the spine or cancer.
All of which have specific treatments.
Rub some dirt on it and walk it off...welcome to socialized medicine.
All of which have specific treatments.
Rub some dirt on it and walk it off...welcome to socialized medicine.
14
What a silly article, for the reasons other readers have described. Really quite dangerous, not to mention offensive: there are many employers who are just waiting to quote an article like this to confirm their own misguided beliefs and enable their lack of empathy. Feels like asking male doctors to discuss the pain involved in having a baby. Surprised this made it past the editors.
25
I'm always doing stupid things to my back.
And what always makes it feel better is the stretching motion that I use to touch up the walls of my house. A little spackling and painting goes a long way to rehabilitating those muscles.
And what always makes it feel better is the stretching motion that I use to touch up the walls of my house. A little spackling and painting goes a long way to rehabilitating those muscles.
Thank you for this well written and informative article.
Refer your patients to the works of John Sarno (ie "Healing Back Pain") as the final piece to curing their pain (especially back, shoulder, sciatica and fibromyalgia). Good Luck!!!
4
Anyone with lower back pain should read John Sarno's books. Lower back pain is this generation's ulcer - mostly stress-related so as to distract your mind from underlying rage and anger. Just reading his book totally cured me.... check out the testimonials on Amazon.
6
Hey bud, thanks so much for posting about sarno. I'm part of a informal network of people that have been cured using his methods (my back, shoulder, and stomach pain). Huge passion of mine is getting the wors out so thanks!
3
Yeah, stress did not cause the genetic defect that led to my body's inability to produce normal, non-defective collagen, the lack of which has wrecked my entire musculoskeletal system from childhood onwards. Unremitting back pain was actually what led to my diagnosis at age 13 with a serious connective tissue disorder; if I had been told to "just deal with it," I would never have been diagnosed, and would never have found out about the gastrointestinal problems or the heart defects either.
I was not unusually stressed out at that age, BTW.
I was not unusually stressed out at that age, BTW.
10
Physical therapy can help to manage chronic lower back pain, but my current Insurance Company makes it unaffordable, since the copay is $50 per visit, and they don't seem as concerned with negotiating the same low rates as other insurance companies where I paid 20%. PT is off and recommended it 3 times a week...that's easily $600 a month. I certainly can't afford that.
8
Plus the PT has to actually be, you know, competent and good at modifying the treatment modalities to fit each individual patient. When I lived in another state, I had a PT from heaven who fit that description perfectly. In NY, where PTs are overseen by the Office of the Professions alongside architects and veterinarians, and educational requirements are not as stringent, things have not turned out well for me.
4
I have had recurring back trouble since I injured my back as a teen. The idea that I could resume normal activities seems pretty unrealistic. I do find that being active helps. Exercising gently in water helps immensely, but when my back is hurting I can barely walk from my car to the pool. I struggle to eat a healthy diet because cooking becomes difficult. The suggestion of doing yoga is highly problematic. I generally do practice yoga, but I can hardly think of a pose that does not require significant modification when my back is "out".
13
Viral infections can cause back pain. Viruses such as varicella zoster (which causes chicken pox and shingles) and herpes simplex (HSV1 and HSV2) lie dormant in the body after initial infection and can re-emerge anytime. Usually an outbreak includes a characteristic rash or herpes lesions. But sometimes the only symptoms are lower back pain and fatigue, with no rash or lesions. Such cases can be very difficult to diagnose.
If you have occasional bouts of intense burning lower back pain, consider asking your doctor to try antiviral treatment as would be used to treat an outbreak of shingles. If a viral infection is causing your back pain, antiviral medication will definitely speed your recovery.
Antiviral medication such as Valtrex is only available via prescription. An over-the-counter supplement, L-Lysine, has also been recommended by some researchers as a valuable tool to fight these viral infections and might be worth a try.
If you have occasional bouts of intense burning lower back pain, consider asking your doctor to try antiviral treatment as would be used to treat an outbreak of shingles. If a viral infection is causing your back pain, antiviral medication will definitely speed your recovery.
Antiviral medication such as Valtrex is only available via prescription. An over-the-counter supplement, L-Lysine, has also been recommended by some researchers as a valuable tool to fight these viral infections and might be worth a try.
5
No question getting up and moving around is important in some cases As a chiropractor that has been practicing for 39 years, back pain is a signal that something is not right. Lack of movement is a contributing factor. More often than not is not the cause. Any pain should be a signal to assess your life physically, nutritionally and mentally. There is a book out there by a medical doctor that says back pain is about 95% mental and you can will yourself out of pain. I believe he was partially right as well. I have had patients that have degenerative conditions, visceral conditions, surgical scars, digestive issues, muscles shortening, muscles weakening, one leg shorter than the other, food sensitivities, environmental toxins and the list goes on and on as causes. Over the years I've found recommending certain nutrients, often times missing from the diet have a profound effect as anti-inflamatories and provide much needed nutrients for other functions of the body. Finding the underlying issue(s) is the name of the game. Address them early speeds recovery, prevents re-occurrences and function improves.
"Take two aspirins and call me in the morning" was a joke and still is a joke. I noticed the author nor the doctors she interviewed could not even mention the word chiropractic as if it would effect the credibility of the article or the doctors reputation. Shame on them.
"Take two aspirins and call me in the morning" was a joke and still is a joke. I noticed the author nor the doctors she interviewed could not even mention the word chiropractic as if it would effect the credibility of the article or the doctors reputation. Shame on them.
6
This advice worked for me. And having seen the wreckage initiated by casual prescription of opioids first-hand, I would not accept a prescription for those unless I were known to be terminally ill.
4
I am delighted to read the guidelines now recommend alternative therapies, including massage. As a medical massage therapist practicing for over 30 years, I have seen many patients walk in with severe pain and walk out with significant improvement. These therapies feel good, provide relief, and have no deleterious side effects.
-Jenny deBeer Charno, LMT, MPH
Glen Cove Massage
Glen Cove NY
-Jenny deBeer Charno, LMT, MPH
Glen Cove Massage
Glen Cove NY
7
Marketing much?
9
The best news The New York Times has printed for months! We need the doctors to start pushing the Insurance Companies to support wellness practices,
and non-invasive therapies, not dependencies
and non-invasive therapies, not dependencies
4
Massage, acupuncture, and yoga are great solutions for lower back pain...now if they were only covered by insurance! My insurance company will cover meds in a heartbeat, but doesn't offer any supportive for alternative therapies.
12
There was no mention of the Alexander Technique and its successfully proven effects on reducing low back pain. One such large published study showing its immediate and long-standing (no pun intended) success in treating low back pain was published in the British Medical Journal in August 2008. Another large published study showed it to be the most cost effective treatment for low back pain, not only providing reduction in the short term, but in prevention of recurrences. It an educational as well as therapeutic technique. A list of practitioners in the US, as well as links to various studies, can be found at Amsatonline.org
3
Is this advice for the young people who hurt themselves doing a sport, or physical activity??? I sadly, and maybe erroneously have had seven spinal surgeries--three fusions. I have Fibromyalgia and have had two atypical, femur fractures due to taking osteoporosis prevention drugs (yeah right, the ones that should make your bones strong! WRONG!). And I am 68 years old. I take one Percocet per day to accomplish some form of a quality of life. I do not want to take more than needed, but you are saying "go out and run, be active, pull my foot over my head, walk, strut, bend, climb????" I do stretching exercises in my hot tub, and walk (using a grocery cart) at the big box stores. I have had physical therapists tell me they have never seen anyone as flexible as I am at my age. Great, but I live in pain. My pain level has not decreased. Injections in the lower spine have not helped and the exact cause for the lumbar/hip pain (everything from bursitis to medial facet-inflammatory syndrome and periformis inflammation) has not been really diagnosed correctly. So, I live with the pain and the limitations it causes. This type of article makes me hurt on a different level in that if what you are saying is true and factual, what do we, the ones who have been chopped and broken do now?
10
30 years ago, I suffered from intractable lower back pain for three and a half years. After NSAIDS burned an ulcer in my stomach I was left with pills like Darvocet (then propoxyphene and acetaminophen) to try to control the pain. CT scans showed nothing (MRI's were experimental at this time). Nothing really helped until I saw a physiatrist (rehab doctor) who prescribed an exercise regimen for me. I got down to controlling my pain with only 2 acetaminophen every 6 hours. Why is this remarkable? Because eventually an EMG revealed something was wrong with my back, and a very carefully done scan revealed a benign bone tumor (an osteoblasyoma) the size of 2 golf balls in my L3 vertebra. This was successfully removed and I have been fine since. Moral of the story: Exercise can help back pain whatever is going on, but you have to know the etiology of the pain. I went through at least 10 doctors, 1 chiropractor, 1 acupuncturist, 6 diagnoses, and 2 negligent scans. Unless you get to the bottom of what is causing the back pain, you will be a fly caught in Hippocrates' web.
13
Walking is good therapy for low back pain, even if it hurts a little, but running?! I don't think so. During the healing period it is essential to observe all those nagging rules about "back health" you read about. Maintain good posture and use proper lifting techniques. Avoid bending and twisting at the same time. Don't move too fast. Use lumbar supports. If you have a strained ligament, a common injury, it will take months before it is fully recovered. So going back to your old bad habits is not a good idea.
11
As a Physical Therapist ( PT) with more than 40 years of clinical experience, I feel that this article is grossly lacking in both, thorough journalistic investigation of current and effective treatments for low back pain (LBP) - ( yes, its PT), and in attending to the REAL suffering of patients. an internist, by professional and clinical training is not an authority on either diagnosing or offering an effective treatment. sending a patient in pain to " go out and run, the pain will get better", is hardly acceptable clinical approach, let alone being a concerned, caring physician. ( that patient should've called the DR. in the middle of the night).
the article needs to further investigate the various clinical approaches currently
utilized by highly trained PT's ( manual / orthopedic PT's) which could be of great, at time immediate help, to back pain sufferers.
the article needs to further investigate the various clinical approaches currently
utilized by highly trained PT's ( manual / orthopedic PT's) which could be of great, at time immediate help, to back pain sufferers.
17
Exactly, Amir! I fell on ice a few years ago, which caused my L4 and L5 discs to tear. I dealt with the initial pain, got better and then got much, much worse. According to my spinal expert, my discs were leaking fluids which irritated the nerves in my low back. At times I could barely walk. I couldn't sleep.
PT and a few steroid injections are the only interventions that have helped. The steroid injections allowed me to do PT. My spinal expert did tell me that it would take a few years for this to settle down, and after 2 years and PT, I'm much better. Muscle relaxants have help a little bit. I'm allergic to anti-inflammatories, so they weren't an option. So yes, waiting helped as did PT. But when your back seizes and you can't walk, sometimes invasive therapies help. PT was the most effective intervention.
PT and a few steroid injections are the only interventions that have helped. The steroid injections allowed me to do PT. My spinal expert did tell me that it would take a few years for this to settle down, and after 2 years and PT, I'm much better. Muscle relaxants have help a little bit. I'm allergic to anti-inflammatories, so they weren't an option. So yes, waiting helped as did PT. But when your back seizes and you can't walk, sometimes invasive therapies help. PT was the most effective intervention.
6
I'm also a PT. I agree with much of what you're saying. Manual therapy is essential in the treatment of low back pain. I do manual work on almost every patient I see.
While I agree with the concept of exercise and keeping active, saying "go out for a run" is ill informed and ridiculous. Exercises to treat pain are prescriptive and should be based on evaluation findings. The exercises that are appropriate for a disc bulge are different than what's appropriate for stenosis. And don't use the internet to find an exercise routine!
While I agree with the concept of exercise and keeping active, saying "go out for a run" is ill informed and ridiculous. Exercises to treat pain are prescriptive and should be based on evaluation findings. The exercises that are appropriate for a disc bulge are different than what's appropriate for stenosis. And don't use the internet to find an exercise routine!
10
When I advised to take a pill , I was referring to an NSAID or the one I find most helpful - an NSAID / muscle relaxant combo sold over the counter in
name brand or generic form . I find it is effective when I just need to get things done . And getting a Doctor's apt in single payer Canada is not easy.
name brand or generic form . I find it is effective when I just need to get things done . And getting a Doctor's apt in single payer Canada is not easy.
1
wonderful article. I do have very bad back pain. I work in IT and ait infront of computer most of the time. The only way i figured i could solve my back issue is through constant exercises and extreme yoga stretching. Dont even waste your time on medications and MRI. Focus on stretching your mindset to do more exercise.
6
My own experiences, for whatever they are worth, are that waiting 5 or more years eventually resulted in my neck, tennis-elbow and back pain going away for the most part. My hips, however, got worse with waiting a few years and they were replaced. My right knee required two surgeries, but is now much better. My ankle, after 20 years of mild soreness after tennis got worse and required surgery to remove a benign mass. My shoulder still makes a racket when I rotate it, but it is manageable. My trigger fingers saw one respond OK to a cortisone shot while the other hurts and if it doesn't improve in a year or two, I'll ask for surgery. So, waiting sometimes helped, and sometimes didn't. Otherwise, I'm good!
3
Finally someone said it, "Take 2 NSAIDS & don't call me in the morning" !
3
Everyone on board with these recommendations should spend at leas 6 months wit severe back pain and being told to "just suck it up" IMHO
27
I can appreciate your frustration with being told to 'suck it up'. However, if you look a bit into the article, you will see that what is further recommended is a variety of alternative therapies. As a medical massage therapist, I see many patients who walk in with severe back pain and walk out with significant improvement. I suggest you give this a try.
-Jenny deBeer Charno, LMT, MPH
Glen Cove Massage
Glen Cove NY
-Jenny deBeer Charno, LMT, MPH
Glen Cove Massage
Glen Cove NY
3
I was going to say the same thing. It's impossible to just suck it up. As a chronic pain sufferer for 10 years. Please give me hope. Don't tell me to walk it off. If it were that easy and effective I would be totally well.
12
The old standby, OTC generic aspirin, is recommended as being a more effective pain reliever then acetaminophen, according to some doctors mentioned in the article. Aspirin is also reported to be much safer than acetaminophen. Even so, acetaminophen has become the preferred OTC pain reliever as a result of the effects of advertising. Perhaps some of the victims of back pain are relying on the wrong pain reliever, having been misled by the unwarranted popularity of acetaminophen.
4
Ms Kolata, you should be ashamed of the blatant bias in this article. over 1,200 words and not a single one references the third largest group of portal-of-entry, insurance covered physicians in the U.S.
Yes, Chiropractic physicians ARE portal of entry physicians with 8+ years of higher education, along with MD and DO's. They ARE covered treatments for back pain by Medicare and every other US insurer. It's negligence to omit such a popular and effective option (that would change the outcome from months of pain to weeks.) I'm stunned that the New York Times editors would allow this article to be published as it is. It certainly hasn't served the reader.
Yes, Chiropractic physicians ARE portal of entry physicians with 8+ years of higher education, along with MD and DO's. They ARE covered treatments for back pain by Medicare and every other US insurer. It's negligence to omit such a popular and effective option (that would change the outcome from months of pain to weeks.) I'm stunned that the New York Times editors would allow this article to be published as it is. It certainly hasn't served the reader.
4
Just to clarify, chiropractors do not have 8 years of graduate education. He is including undergraduate education. MDs and DOs have significantly more training including a minimum of (7years post undergrad) three years plus for residency. Please do not equate chiropractors with physicians. The use of the terminology chiropractic physician is very misleading and confusing.
10
Wow, lots of opiate addicts here looking at the comments. If you are on opiates for more than a month, you are a drug addict. Its as simple as that. As a former drug addict whose opiate medication was initially supplied by a doctor, I know. Opiates should only be given to people for 1 week at a time. You should not be allowed to take opiates for more than a month unless you are completely disabled or about to die. Opiates are deadly, sinister drugs that lead directly to death or a life as a opiate zombie.
Its so obvious once you have admited that you are a drug addict. The problem is going to be convincing thousands of people who are addicted to opiates but believe that they need them in order to live.
Its so obvious once you have admited that you are a drug addict. The problem is going to be convincing thousands of people who are addicted to opiates but believe that they need them in order to live.
3
"It's as simple as that." The Times would rightly censor my post if I put down what I think of your comment. Some people have had severe injuries or health problems which are as fixed as they are going to be. They need to take opiates. My friend in a wheelchair with the crushed spine who was a paraplegic took opiates. The smugness of the anti drug at all times for everyone crowd is sickening.
7
NO. I'm a former heroin addict that started pain pills from a car accident, but dependency DOES NOT equal addiction. You should know that if you are an addict.
2
Jacqueline,
You have no understanding of addiction. I'm sorry that you have struggled with addiction. Addiction rips up lives. Congratulations on your sobriety.
Addiction is a disease that results in
-the compulsive use of a medication or substance
-the inability to control that use
-continued use despite harm caused to self or others.
Addiction often include cravings for that medication or substance.
Using an opiate for more than a week isn't an addiction.
Based on another comment by you, it is my opinion that your perception of opiate use is skewed by your personal experience. In no way do your comments match the medical definitions and research regarding addiction.
You have no understanding of addiction. I'm sorry that you have struggled with addiction. Addiction rips up lives. Congratulations on your sobriety.
Addiction is a disease that results in
-the compulsive use of a medication or substance
-the inability to control that use
-continued use despite harm caused to self or others.
Addiction often include cravings for that medication or substance.
Using an opiate for more than a week isn't an addiction.
Based on another comment by you, it is my opinion that your perception of opiate use is skewed by your personal experience. In no way do your comments match the medical definitions and research regarding addiction.
6
Every now and then my lower back "goes out" for different, and, sometimes, no discernible reasons. When it happens, I've learned that whatever I do the pain will not get worse so I slog through it. Aspirin work when I have to be present somewhere. So, for some reason, does coffee. When co-workers see me shuffling along looking like a very unhappy question mark, they know not to ask, "How are you doing?" When I get home, judicious intake of weed, smoked, not ingested, works. In its own time the pain goes away till the next time...
Yeah, I know we're all different. Just sayin, ya know...
Yeah, I know we're all different. Just sayin, ya know...
8
(Part 4)
Another revelation was my hypothyroidism: I was always bad about refilling my prescription on time and would often go several days without before getting resupplied until I realized that if I went without for a few days my lower back muscles would become increasingly tight/kinked --especially if I was under a lot of stress. (I remember one such occasion, getting off a tense and protracted call with my GF and realizing my back was tight when it had been fine before the call.) I could be wrong, but I now guess that the Thyroid hormone plays some part in stress response, perhaps as a moderator?
Another insight: chairs DO make a difference. My GF started having back problems while I was worked out-of-state for an extended period of time. A week or three after my return I realized MY back was getting kinked up too. Long story short, since my back wasn't constantly tight/painful I was able to realize that when I sat in one of the pair of easy chairs she had bought while I was away, my back began to tighten. The chairs had long seats, meaning that with the backs of our knees against the chair, our backs weren't fully against the chairs --we had to unconsciously curl our lower backs and slouch to make full contact. Once we bolstered each chair with a thick bed pillow we both felt fine pretty quickly.
(Continued...)
Another revelation was my hypothyroidism: I was always bad about refilling my prescription on time and would often go several days without before getting resupplied until I realized that if I went without for a few days my lower back muscles would become increasingly tight/kinked --especially if I was under a lot of stress. (I remember one such occasion, getting off a tense and protracted call with my GF and realizing my back was tight when it had been fine before the call.) I could be wrong, but I now guess that the Thyroid hormone plays some part in stress response, perhaps as a moderator?
Another insight: chairs DO make a difference. My GF started having back problems while I was worked out-of-state for an extended period of time. A week or three after my return I realized MY back was getting kinked up too. Long story short, since my back wasn't constantly tight/painful I was able to realize that when I sat in one of the pair of easy chairs she had bought while I was away, my back began to tighten. The chairs had long seats, meaning that with the backs of our knees against the chair, our backs weren't fully against the chairs --we had to unconsciously curl our lower backs and slouch to make full contact. Once we bolstered each chair with a thick bed pillow we both felt fine pretty quickly.
(Continued...)
1
I'm in good shape and exercise regularly, nevertheless, I've suffered from chronic back pain for most of my life. I had some scans done a decade or so ago and they showed a lot of impinged this and pinched that. As my doctor said - it confirmed my symptoms. Most of the time it's just a low level discomfort that I've learned to ignore, but from time to time and for no discernible reason it will flare up and leave me feeling crippled with pain. Sometimes this will last just a day or so and other times it has gone on for a couple of months. Ibuprofen doesn't make much of a dent in this extreme pain, but if I take a Percocet it will SOMETIMES give me enough relief that I can resume something close to a normal posture and move in a somewhat normal manner. I find that if I can straighten up and move it will often, not always, help me get over the acute pain much quicker. I take it just once or twice over the course of a day or two and stop because if that doesn't do the trick I know that it's not going to work this time and I make do with ibuprofen and whining.
8
So much about opiod addiction is misunderstood and the Times certainly has contributed to it with simplistic statements like claiming that the abuse epidemic "often begins with a 'simple prescription' for ailments like back pain."
Most often, research shows that opiod abuse occurs either in people who start out not with pain but a mood disorder or simple desire for euporhia or in people who receive a series of prescriptions over a longer period, beyond their need and without prescribing simultaneous, non-pharmacological measures.
Blatantly false, as well, is the idea that going out running will relieve pain. Running is universally one of the worst exercises to perform because of the extreme pounding the body takes over time.
Any simplistic treatment approach or description of pain as an "annoyance" relieves doctors from their real responsibilities. Cookbook approaches rarely work. To do their jobs, physicians shouldn't so much educate the patient as listen to the patient. Doctor healing requires taking the time to assess how crippling the pain is and how realistic are a myriad of solutions in each, individual situation.
Deciding that an abuse epidemic drives medical decisions, instead of allowing individual situations to drive medical solutions, is as bad an idea as automatically reaching for the prescription pad.
Most often, research shows that opiod abuse occurs either in people who start out not with pain but a mood disorder or simple desire for euporhia or in people who receive a series of prescriptions over a longer period, beyond their need and without prescribing simultaneous, non-pharmacological measures.
Blatantly false, as well, is the idea that going out running will relieve pain. Running is universally one of the worst exercises to perform because of the extreme pounding the body takes over time.
Any simplistic treatment approach or description of pain as an "annoyance" relieves doctors from their real responsibilities. Cookbook approaches rarely work. To do their jobs, physicians shouldn't so much educate the patient as listen to the patient. Doctor healing requires taking the time to assess how crippling the pain is and how realistic are a myriad of solutions in each, individual situation.
Deciding that an abuse epidemic drives medical decisions, instead of allowing individual situations to drive medical solutions, is as bad an idea as automatically reaching for the prescription pad.
22
Incisive and important comment, Ms. Rogers. I would add in Maia Szalavitz's reportage on opioids, which shows that most pain patients are personally unfamiliar with the black markets for opioids and would not know where to find those markets; the people who are most likely to buy opioids off the street for fun or to feed an addiction are those who are already buying other drugs off the street for fun or to feed an addiction.
4
Oh, you are in pain? Well, stay that way for a few months and see if it gets better. Seriously? If that isn't the stupidest thing ever said, I don't know what is. First of all, many people experience severe back pain as a RESULT of overdoing certain physical tasks, (I know I do), so to tell them to go and exercise, and further irritate the area that is already injured is pretty stupid advice. When I am in that situation my chiropractor tells me to rest it, ice it, and take anti inflammatory meds. That, along with some adjustments, does the trick. After treatment, I am recovered in a few days. I have been in such severe pain, I couldn't even get out of bed. If anyone told me to just suffer and wait it out, I would report them to the licensing board as a complete quack.
19
Go see you Family Doctor/osteopathic physician!
Osteopathic manipulative treatment (OMT) significantly reduces pain and improves functional status in patients, including pregnant and postpartum women, with nonspecific acute and chronic LBP.
Franke et al found that in acute and chronic nonspecific LBP, moderate-quality evidence suggested that OMT had a significant effect on pain relief and functional status.
More specifically, in chronic nonspecific LBP, the evidence suggested a significant difference in favor of OMT regarding pain.
Osteopathic manipulative treatment (OMT) significantly reduces pain and improves functional status in patients, including pregnant and postpartum women, with nonspecific acute and chronic LBP.
Franke et al found that in acute and chronic nonspecific LBP, moderate-quality evidence suggested that OMT had a significant effect on pain relief and functional status.
More specifically, in chronic nonspecific LBP, the evidence suggested a significant difference in favor of OMT regarding pain.
7
The guideline did look at spinal manipulation and found there was only very low-quality evidence to support its efficacy and that acupuncture and massage both of which are much safer are equally efficacious.
1
"Waiting it out"? That's what my primary care doctor made me do in 2010, when I slipped but did not fall. I had back and knee pain, and was told to use a heating pad and ice my knee. 4 weeks later, I finally was given a referral to a orthopedist; he ordered x-rays, and discovered I was walking, going to work,etc. with a fractured knee-cap and torn meniscus. I hen had to spend 1 year of physical therapy to be able to walk any distance without falling. Now I also have bone-to-bone osteo arthritis. I'd ignore this study if I was the reader.
14
Excuse me but what does having trauma to the knee have to do with guidelines on back pain. And by the way if there is traumatic injury to the back and pain subsequently develop, radiographic workup is indicated. However, most patients with back pain have not suffered any such trauma.
And as to your arthritis, as a physician I can tell you that waiting four weeks or even four months would have had no effect on your developing it.
And as to your arthritis, as a physician I can tell you that waiting four weeks or even four months would have had no effect on your developing it.
4
Aside from the obvious side effects, opioids, valium, etc do not address the cause of chronic or acute back pain. The readers comments here all demonstrate the wide variety of underlying causes. The X rays done of my spine over the years have shown it to take on "whimsical" configurations.
Don't underestimate what muscle spasms can do to normal spinal alignment. The x ray films now help me to estimate how much work I have to do to get better. For me that's exercise, but first you deploy mindfulness to live with the pain. I'm self-taught from the books by Dr Jon Kabat-Zinn.
I learn to get moving "as soon as I can"; which is a self-enforced 24 hour time limit. Exercise is walking, and if you have access to a pool, swimming. More is better. Physical therapy with myofascial release and Swiss ball is helpful but it's tough to find therapists that have enough training and experience.
...and yes you can run, but do this backwards on an artificial running track. Stay in a lane, and pick a lane that others are not using, so you don't have to look over your shoulder.
Don't underestimate what muscle spasms can do to normal spinal alignment. The x ray films now help me to estimate how much work I have to do to get better. For me that's exercise, but first you deploy mindfulness to live with the pain. I'm self-taught from the books by Dr Jon Kabat-Zinn.
I learn to get moving "as soon as I can"; which is a self-enforced 24 hour time limit. Exercise is walking, and if you have access to a pool, swimming. More is better. Physical therapy with myofascial release and Swiss ball is helpful but it's tough to find therapists that have enough training and experience.
...and yes you can run, but do this backwards on an artificial running track. Stay in a lane, and pick a lane that others are not using, so you don't have to look over your shoulder.
7
Maybe I missed it but I saw no mention of chiropractic doctors in the article. I understand that a lot of orthopedic doctors are not enthusiastic about chiropractors, but I have suffered from lower back pain on and off since I was in a car accident at the age of 19 and an excellent chiropractor was the only remedy in addition to a lot of walking and other exercises.
5
As a former opiate addict, I can say this is a good thing. I didnt have back pain, but I did buy a lot of pills from people who had back pain. Generally, older people would get on SSI and Medicaide, and then they would ahve their opiate dose increased so much that they couldnt even leave the house.
I cant even remember the number of old people I used to buy pills from. You would go into some disgusting house and find the old person sitting on a chair with everythinf they need to live around them. They couldnt work anymore because they were so out of it, so they sold half their pilla a month to pay for what they needed. For example, Medicaide would pay for a month of dilaudid pills for one of these old people. The old person may get like 120 dilaudids a month for free. By seeling 60 of them at $40 a piece, they could make $2400 a month extra for themselves.
You can tell me that people need pain pills, and thats true. However, I can also tell you that old people on disability are the number 1 source of opiates for young addicts.
I am so grateful that I was able to get sober. Ive been sober for 5 years now, but my insurance wont even cover suboxone. Ive been paying $400 a month in Obamacare premiums, and $300 a month for the suboxone. Meanwhile, these drug dealers get free medication and actually make a a profit off their disability. I think our priorities are really out of whack.
I cant even remember the number of old people I used to buy pills from. You would go into some disgusting house and find the old person sitting on a chair with everythinf they need to live around them. They couldnt work anymore because they were so out of it, so they sold half their pilla a month to pay for what they needed. For example, Medicaide would pay for a month of dilaudid pills for one of these old people. The old person may get like 120 dilaudids a month for free. By seeling 60 of them at $40 a piece, they could make $2400 a month extra for themselves.
You can tell me that people need pain pills, and thats true. However, I can also tell you that old people on disability are the number 1 source of opiates for young addicts.
I am so grateful that I was able to get sober. Ive been sober for 5 years now, but my insurance wont even cover suboxone. Ive been paying $400 a month in Obamacare premiums, and $300 a month for the suboxone. Meanwhile, these drug dealers get free medication and actually make a a profit off their disability. I think our priorities are really out of whack.
5
My pain management clinic makes me come in every two months, pulls surprise urine tests and pill counts and limits how much opiates you can get. That's the only way they should be provided.
5
Yeah let's put the opiate problem blame on old people.
As if you did not have choices earlier in your drug habit.
I happen to know that many younger people also steal their drugs from relatives or someone that they work for. Happy you got sober but do NOT put your personal woes on others.
As if you did not have choices earlier in your drug habit.
I happen to know that many younger people also steal their drugs from relatives or someone that they work for. Happy you got sober but do NOT put your personal woes on others.
8
@NY--agreed. But cue the wails from people who, although they had no trouble getting to a doctor or pharmacy to get their prescriptions to date, suddenly are "unable" to go to pain management clinics where their drug use will be limited and monitored.
If you are in acute pain, how is someone supposed to get on with their lives when going to the bathroom is an ordeal? Not to mention that insurance companies cap PT visits, if they pay at all. 10 visits a year is NOTHING.
12
I have spinal stenosis characterized as severe, putting me in a group of less than 3% of all people with lower back pain. It never gets better, it only gets worse. I have already had a C4 through C7 fusion, but that was neck surgery, and my neurosurgeon does not recommend doing the lower back until I reached the point where I can barely walk. I was close to that 3 years ago, but my condition had been aggravated by inappropriate chiropractic treatments, and it took 6 months to resolve. Since then, I not only suffer from chronic lower back pain but systemic arthritis as well. I'm only 56.
The only way I managed to function is not only due to the Tylenol, ibuprofen and Lyrica I take regularly, and periodic steroid/anesthetic injections into my spine, but also thanks to a dose of Percocet every so often, which allows me to sleep through the night.
Please, when vilifying opioids, try and remember that not all of us are addicts, or would prefer being an addict to being in chronic pain so severe that we are prevented from working, and we need that to keep a roof over our heads.
The only way I managed to function is not only due to the Tylenol, ibuprofen and Lyrica I take regularly, and periodic steroid/anesthetic injections into my spine, but also thanks to a dose of Percocet every so often, which allows me to sleep through the night.
Please, when vilifying opioids, try and remember that not all of us are addicts, or would prefer being an addict to being in chronic pain so severe that we are prevented from working, and we need that to keep a roof over our heads.
18
Very well said. I'm sorry that you ate in such pain. Good luck.
3
Like many commenters, fury was my first reaction. Make no mistake - if you are told by a doctor to try yoga or aspirin, you're being dismissed. It's quite easy to have ideas about pain and treatment, until you're the one experiencing it.
As for the opioid "epidemic" - it's yet another issue that is turned into a national emergency because it's started to affect some upper-middle class white people. To restrict access to pain medications because some will misuse it is punishing people who are already suffering, even of some of the people who misuse it look like the "kid next door." Addicts of other demographics are given jail time. Although that's an enormous failure and a horrible idea, it shows how so many people who have preached about personal responsibility have no trouble blaming the system when it's their kid.
As for the opioid "epidemic" - it's yet another issue that is turned into a national emergency because it's started to affect some upper-middle class white people. To restrict access to pain medications because some will misuse it is punishing people who are already suffering, even of some of the people who misuse it look like the "kid next door." Addicts of other demographics are given jail time. Although that's an enormous failure and a horrible idea, it shows how so many people who have preached about personal responsibility have no trouble blaming the system when it's their kid.
10
Race doesnt matter to drugs. Opiates are highly addictive. The comments by people like you prove it. People on opiates hate these new rules and regulations because they are afriad of living life not in an opiate induced daze. Opiates actually create pain in the long run. People addicted to opiates will believe their pain is coming back everytime they skip a pill. The reason is that their brains want the opiates, and psycosomatically create the pain in order to feed the addiction.
I know this for a fact. I was put on opiates because of an ulcer, and when I tried to quit the opiates the pain came back worse than ever. I eventually quit opiates after a long time in addiction, and suddenly 3 months later I had no pain at all.
I know this for a fact. I was put on opiates because of an ulcer, and when I tried to quit the opiates the pain came back worse than ever. I eventually quit opiates after a long time in addiction, and suddenly 3 months later I had no pain at all.
1
Wait. Comments that acknowledge the complexities of pain treatment and appropriate opiate use are evidence of addiction? Uh ... no. You are profoundly undereducated about the complexities of chronic pain, the appropriate use of medications and the most basic medical research on addiction.
6
I was told I had a pinched nerve and the pain would be chronic. It lasted for nearly three years and then went away without pills or therapy. My daughter suggested I do what I had done before when I had back pain....nothing! I rested my back because it hurt too much to be active. The article is correct in that x-rays don't help. Mine showed a lot of damage that is age-related but not necessarily pain producing.
5
I developed a severe case of sciatica while traveling abroad, this was not my first encounter with the condition and the hotel staff advised that I speak with their doctor. The usual treatment had the usual result...none. Finding the film, "The Man Who Came to Dinner", on TV at 3:00AM did however afford me some momentary relief. About six weeks after the onset, I was in my car, backing out of my parking space when I suddenly realized I hadn't had to lift my leg into the car and I had no pain driving. Naproxen, heat and classic film comedies are now my go to remedies when my abused spine misbehaves.
1
I've gotten to where I just hate reading articles like this which assume every back twinge just gets better on its own.
MRIs are worse than useless? What else would have shown the blown disc at L3 that had crushed my Sciatic nerve? Certainly not X-Rays which go through soft tissue and show little. They certainly didn't show the pieces of the disc covering that had traveled down the nerve channel requiring extra cutting to remove them. Am I fine today? No. I've lost 90% of nerve conductivity, the lymph nodes are filled with liquid and I have edema. Constant pain punctuated with bursts of more intense pain go on all the time and even wake me at night. And that's with 90 mg of MSContin every day.
The L3 on the left failed due to stenosis. X-Rays don't pick that up either. Same problems today as I have on the right.
When you have so much pain that you can't get up from a kneeling position you need to get whatever diagnostic tools are available. I'd rather rule out the worst case problems than assume it's just a temporary ailment. Waiting too long will most likely make your problem worse than it is.
MRIs are worse than useless? What else would have shown the blown disc at L3 that had crushed my Sciatic nerve? Certainly not X-Rays which go through soft tissue and show little. They certainly didn't show the pieces of the disc covering that had traveled down the nerve channel requiring extra cutting to remove them. Am I fine today? No. I've lost 90% of nerve conductivity, the lymph nodes are filled with liquid and I have edema. Constant pain punctuated with bursts of more intense pain go on all the time and even wake me at night. And that's with 90 mg of MSContin every day.
The L3 on the left failed due to stenosis. X-Rays don't pick that up either. Same problems today as I have on the right.
When you have so much pain that you can't get up from a kneeling position you need to get whatever diagnostic tools are available. I'd rather rule out the worst case problems than assume it's just a temporary ailment. Waiting too long will most likely make your problem worse than it is.
13
As a physician I can tell you that if your sciatic nerve was truly "crushed" you'd have had a lot more problems than just pain.
And by the way, if your pain is due to any type of nerve injury, opioids like MSContin provide little benefit. You should be on drugs that actually help this form of pain like Lyrica, Neurontin, and Cymbalta.
And by the way, if your pain is due to any type of nerve injury, opioids like MSContin provide little benefit. You should be on drugs that actually help this form of pain like Lyrica, Neurontin, and Cymbalta.
4
Isn't constant pain qualifying? How about the edema? Being unable to get off the floor without leaning on my cane?
You're right. The MSContin doesn't provide enough relief.
Neurontin (Gabapentin) Are you aware that it and it's replacement Lyrica (Pregabalin) can cause depression and suicidal ideation in some people? I was one of them. Quitting the gabapentin restored me to normal in a couple of weeks after almost a year of misery. It also causes insomnia in some folks and extreme flatulence. You also gain weight.
Check out the hundreds of millions of dollars the FDA has dumped on the manufacturer. Check out how many insurance companies are suing them. When they're done the rest of us are going after them ti take what's left.
You're right. The MSContin doesn't provide enough relief.
Neurontin (Gabapentin) Are you aware that it and it's replacement Lyrica (Pregabalin) can cause depression and suicidal ideation in some people? I was one of them. Quitting the gabapentin restored me to normal in a couple of weeks after almost a year of misery. It also causes insomnia in some folks and extreme flatulence. You also gain weight.
Check out the hundreds of millions of dollars the FDA has dumped on the manufacturer. Check out how many insurance companies are suing them. When they're done the rest of us are going after them ti take what's left.
3
The highlighted "new" recommendation is silly, among the many listed. Lower back pain, the typical kind that goes away after a while, has been treated by humans themselves with home remedies since the dawn of our species on earth. I already learned this from my mother more than 60 years ago, when she said, "Keep moving, you'll feel better, but take it easy for a while" when my back hurt. Gee, it sounds like these physicians agree with my mother, bless her soul.
Lower back pain, the chronic radicular kind, is not well treated anywhere, including here. I have had this kind for more than three years. I followed all the listed non-invasive recommendations, yet nothing has really helped my pain for long, except opioids.
When will medicine get off this stop-the-drugs fad, and instead admit that their recommendations are mostly guesses? So, please explain why Tylenol is now no good for back pain when it was great in 2007. The risk of addiction model is also a stupid concept, unless medicine learns to study data on people with controls for their addictive tendencies. Get a real diagnostic measure of that risk first, then analyze the correlation data on a benefit vs. risk. What makes me different that a regular dose of an opioid, hydrocodone, has helped my pain and not made me addict in three years?
Lower back pain, the chronic radicular kind, is not well treated anywhere, including here. I have had this kind for more than three years. I followed all the listed non-invasive recommendations, yet nothing has really helped my pain for long, except opioids.
When will medicine get off this stop-the-drugs fad, and instead admit that their recommendations are mostly guesses? So, please explain why Tylenol is now no good for back pain when it was great in 2007. The risk of addiction model is also a stupid concept, unless medicine learns to study data on people with controls for their addictive tendencies. Get a real diagnostic measure of that risk first, then analyze the correlation data on a benefit vs. risk. What makes me different that a regular dose of an opioid, hydrocodone, has helped my pain and not made me addict in three years?
6
Be careful. When I was a drug addict the number 1 source of pills was hyper addicted old people on SSI. They may have had their pain relieved, but oftentimes they would get stuck in an opiate daze and never leave their living room. I remember 1 lady with lower back pain who had all her needs within reach of her chair. She sold half her pills a month to pay rent, and I bought from her for months. Every single time I came over, she was sitting in the exact same chair. I dont believe she ever actually left that chair. You know whats interesting? She didnt consider herself an addict, even though she took up to 6 dilaudids a day. I found that amazing because she also had a huge abscess on her arm from trying to inject those pills. She was telling me she wasnt an addict while pus and blood flowed out of her own arm. Denial is a big force. Be wary of denial. 3 years of opiates, you are probably physically addicted. Can you stop taking the pills for more than two days? If you cannot, then you are an addict. If you can, make sure that doesnt change.
1
(Part 1 of 2 comments)
John Sarno's "Healing Back Pain, The Mind Body Connection" literally saved my life.
I injured my back at 20, after a weekend of moving heavy equipment. In 25 years there were only a handful of days without either chronic or acute pain. At one point, 15 years in, I realized I had seen one orthopedist, neurologist, or neurosurgeon for every year of the problem.
At 30 an orthopedist showed me an MRI of L5-S1 and told me he didn't understand how I could even walk and initially offered surgery before inexplicably backtracking. By 41 that disk had pancaked and L4-L5 was implicated and I had a micro-discectomy that addressed acute pain, but still had chronic pain.
I hit bottom in 2004. I couldn't stand up straight, bend over, or take more than about an 8" stride without pain. I would spend an hour stretching to prepare for the 45 minute commute to/from the office in Basking Ridge.
I was all set to take every pill I had.
I credit Dr. Sarno with saving my life, but I thank a co-worker named Neil, too, who had seen the doctor and recommended his book.
With my pills as backup, I decided I had nothing to lose: I went out for a light 15 minute jog, followed by light stretching.
The next day I wasn't any worse for wear, so I repeated the jog and stretching.
Within a few days I had less pain, more range of motion. I kept it up and within a few weeks I was able to return to doing BB drills, followed by the same stretches.
(Continued in part 2.)
John Sarno's "Healing Back Pain, The Mind Body Connection" literally saved my life.
I injured my back at 20, after a weekend of moving heavy equipment. In 25 years there were only a handful of days without either chronic or acute pain. At one point, 15 years in, I realized I had seen one orthopedist, neurologist, or neurosurgeon for every year of the problem.
At 30 an orthopedist showed me an MRI of L5-S1 and told me he didn't understand how I could even walk and initially offered surgery before inexplicably backtracking. By 41 that disk had pancaked and L4-L5 was implicated and I had a micro-discectomy that addressed acute pain, but still had chronic pain.
I hit bottom in 2004. I couldn't stand up straight, bend over, or take more than about an 8" stride without pain. I would spend an hour stretching to prepare for the 45 minute commute to/from the office in Basking Ridge.
I was all set to take every pill I had.
I credit Dr. Sarno with saving my life, but I thank a co-worker named Neil, too, who had seen the doctor and recommended his book.
With my pills as backup, I decided I had nothing to lose: I went out for a light 15 minute jog, followed by light stretching.
The next day I wasn't any worse for wear, so I repeated the jog and stretching.
Within a few days I had less pain, more range of motion. I kept it up and within a few weeks I was able to return to doing BB drills, followed by the same stretches.
(Continued in part 2.)
5
Thank you for pointing out Dr. Sarno's book. Dr. Sarno struggled with terrible back pain so as a doctor he understood. His book empowered me to take responsibility for everything I can do to improve my situation. I still have to take medication and often have terrible pain but keeping my weight down and trying as many things as I can at home and giving things a shot (meditation, a less stressful life) have given me a feeling of more control in my life and I feel proud at least for my diet changes and what I can do on my part. Often we want to just be fixed and the doctors don't explain that it's not so simple. Compassion is huge for people in pain and education. His books have changed my life.
3
I had worsening back pain for about 3 years and then succumbed to back surgery. I received no relief from my original pain and limitations, and it took a year to recover from the surgical pain. HOWEVER, 2 months ago I was referred to cardiac rehab and exercise like a mad woman for 3 hours a week. I have finally been freed of my back pain. I'm part angry, but mostly relieved. Angry because of the many doctors I consulted, not one suggested that vigorous exercise would be helpful. fortunately, I did not go the opiod route or this would possible have a different ending.
One more thing, massage and acupuncture are not covered by insurance so are not options for most people. If doctors really believe in these treatments, they should be agitating for people to receive insurance coverage.
One more thing, massage and acupuncture are not covered by insurance so are not options for most people. If doctors really believe in these treatments, they should be agitating for people to receive insurance coverage.
12
Strengthen the core with Pilates; increase flexibility with Yoga,
Lose weight. Avoid demon Sugar, sodas, and acid-producing foods!
Take-in organic, anti-inflammatory food and drinks everyday, that can reduce both pain + inflammation.
Here's one that works: Tumeric, lemon, ginger, aloe vera juice, apple cider vinegar, and lemon.
Lose weight. Avoid demon Sugar, sodas, and acid-producing foods!
Take-in organic, anti-inflammatory food and drinks everyday, that can reduce both pain + inflammation.
Here's one that works: Tumeric, lemon, ginger, aloe vera juice, apple cider vinegar, and lemon.
4
I certainly support a greater emphasis on things like alternative therapies and good old-fashioned exercise, but this seems unnecessarily cruel. It sounds like the idea is to tell patients to just get over it. Really?
There's back pain, and then there's back pain. Certainly your run-of-the-mill aches can be helped enormously by staying fit and taking a few ibuprofen when needed, but what if your back hurts so bad you can barely manage to do anything but lie still on flat surface? Go for a run, you say? What if I can't even load the dishwasher without excruciating pain?
Maybe it will resolve on its own in a few months, but what do you do till then? These doctors seem to forget that most of us out there have demanding jobs to attend to, kids to take care of, houses to maintain, etc. -- and insurance plans that don't cover things like acupuncture and massage. Guess what, pills are cheap and they make the pain stop, and that can be the difference between living your life and just muddling through in agony day after day.
I get that the "opioid crisis" currently underway is in part due to widespread overprescribing of these drugs dating back to the '90s, but now it seems like the pendulum is swinging too far in the other direction, and doctors are being encouraged to ignore or dismiss their patients' very real pain and suffering. Please, can't we just have a little moderation and common sense for once in this country?
There's back pain, and then there's back pain. Certainly your run-of-the-mill aches can be helped enormously by staying fit and taking a few ibuprofen when needed, but what if your back hurts so bad you can barely manage to do anything but lie still on flat surface? Go for a run, you say? What if I can't even load the dishwasher without excruciating pain?
Maybe it will resolve on its own in a few months, but what do you do till then? These doctors seem to forget that most of us out there have demanding jobs to attend to, kids to take care of, houses to maintain, etc. -- and insurance plans that don't cover things like acupuncture and massage. Guess what, pills are cheap and they make the pain stop, and that can be the difference between living your life and just muddling through in agony day after day.
I get that the "opioid crisis" currently underway is in part due to widespread overprescribing of these drugs dating back to the '90s, but now it seems like the pendulum is swinging too far in the other direction, and doctors are being encouraged to ignore or dismiss their patients' very real pain and suffering. Please, can't we just have a little moderation and common sense for once in this country?
133
When my daughters had their wisdom teeth removed they were given a 30-day prescription for Vicodin. They probably each used 2 or 3, and the remainder stayed in the medicine cabinet for years until I threw them out. Nowadays I understand kids will ask to buy the unused pills. Why can't they just prescribe a few? My husband has had knee and shoulder surgery, same thing. He never used more than a couple of pills also.
1
How in the world is it even possible that in this day and age the article does not mention Chiropractic Care? The structure of your body and its relationship to your spine will determine how weight and stress are distributed. Its obvious that your tires will wear out sooner if your car is out of alignment. As a practicing Chiropractor since 1980 I am dismayed to see the lack of knowledge and/or prejudice that still exists toward my profession. Millions more people could be helped if they truly understood what we do. Chiropractic, Acupuncture, Massage Therapy, Physical Therapy and Exercise should be your go to choices for back pain. I am glad to see the article point out that covering your pain with drugs is not the answer and has never been a long term answer except in rare cases.
1
Another article disparaging opiates. Once again I look the picture of health. Perfect weight,swim 5 miles a week Have taken these pilloried drugs for 10 years and they work! I can't afford a full time masseuse and have a hard time thinking of life without them. I have tried and it hurts. But those of you who abuse these drugs shame on you!
17
This is common sense supported by my own experience. I often find that getting out for a run is what makes my aching back feel better. I am lucky that my primary care doctor is also a sports medicine specialist whose mantra is to "keep moving, stay active." When I've seen him for back or hip pain that I fear is something severe, he points me back on the path of more activity. Occasionally a little physical therapy to establish a regime of stretching and exercise. My experience confirms that staying active is the best way to deal with ordinary pain.
1
I am in my 60's have suffered with back problems in recent years, bulging discs, scoliosis, spasms, issues with my feet that may be connected to the back. My doctor here in France has never prescribed narcotic meds nor to see a surgeon unless the situation becomes such that there is no other choice. One time I couldn't get up from the floor, so he made a house call which doctors still do in France and gave me a shot which allowed me to get up Instead I have been subscribed various anti-inflam to see which worked best and over the counter pain relievers and massage therapy and was encouraged to be patient. I think this is the key- PATIENCE, we all want instant relief but remember many back problems are cumulative from years of perhaps poor posture or just bad luck. I was incapascitated for a few months last summer with one of these episodes and understand during these terrible times one can only rest. A pilates teacher advised me to see an Osteopath (not Chiropracter) one who is highly regarded in my region and she helped me enormously. Look for a good one, not all are the same. I was advised to walk for a half hour on flat ground every day and lie flat on my back for a half hour daily. I use this time on my back to listen to body scan meditations videos on UTube which I highly recommend. Look for Michael Sealy or Rosa Lukosuite both excellent! Also find a good Pilates class and do some swimming if you can, both have helped me. Hope this long comment helps someone out there.
1
Do you work? And does your employer give you the time off to watch the videos, etc.?
4
Retired, if you are younger do what you can now, pay attention to your posture, keep your core muscles strong, bend correctly.
2
I am in full agreement with this article. My occasional (and minor) lower back issues have best been helped by a steady intake of ibuprofen and a heating pad. All the other treatments, seeing doctors, MRIs, PT, etc., have just been busywork while I waited it out. It amazes me that, despite an aching lower back, and other aches and pains, I can tango the night way, pain free!
That said, my sympathies to those who suffer intolerable pain.
That said, my sympathies to those who suffer intolerable pain.
2
Do some back exercises every day and hopefully you will get less episodes of back pain.I went from daily pain,back in the 1970's to now,having much less episodes and less pain when I get them.Don't depend on some miracle cure from doctors and try to avoid surgery.Get your spine stronger and more flexible and your spine will reward you.
Nothing new here, these "guidelines" have been common knowledge for years. What we really need is something to relieve the pressure caused by drug companies marketing directly to patients.
3
So, the gist of this article whose title suggests a huge revelation with regard to back pain is if you strain your back or pull a muscle, don't take opioids and move to keep the area limber. I completely disagree with the statement that scans "are worse then useless for back pain", "results can be misleading, showing what look like abnormalities that actually are not related to the pain." About 20 years ago my brother ruptured a lumbar disc lifting a chair in his living room. He could not walk and began losing sensation in his feet, lower legs & did not feel a rectal exam performed by the emergency room doctor. He ended up being transferred to another hospital with a neurosurgery service for emergent surgery----without the scans, surgery and pain medications, he would be in a wheelchair today. Had he "taken 2 aspirin and called the doctor in the morning", he wouldn't have walked ever again. ALL acute pain should be evaluated and the statement that "Back pain has a natural course that does not require intervention" is the most ridiculous statement I've heard. There are many causes of back pain, including malignant masses, cysts, bone spurs and others, and saying that most people with acute back pain do not have to see a doctor at all is irresponsible, in my opinion. I think people seek a doctor's help because when your back is hurt, it affects your entire life---you can't "go out and run" when it feels like a knife is being wedged into your spine.
29
The guidelines are for chronic pain, not acute injury. Admittedly it's not always obvious which category you're in as a patient in pain but your brother's case is pretty clearly an acute injury. I know from my own experience as a patient in Weinstein's Spine Center at Dartmouth that he supports surgery for cases such as these.
What if the back pain is caused by a herniated disc? Can exercise do more damage or cause additional pain?
5
Depends on the exercise. Avoid anything that will compress the spine. Consult a professional physical therapist.
one size does not fit all
2
Yet this article and most of the comments assume it does.
3
I truly that every MD who contributed to this change ends up with disc slippage,cracked vertabae,torn muscles and the endless gnawing pain I have after 36 years of Nursing. Let me tell you something about MDs. They do not know everything.
9
And most of them don't really care.
3
I understand the grinding way that severe chronic pain tears at your soul and takes your life. My 18 year old has been in severe chronic pain for probably half of the last five years. I wish there was a pill to fix him. There isn't. But those suggestions - exercise, meditation, biofeedback, tai chi, acupuncture, chiropractor, physical therapy? They have. They take a lot of work and they put the responsibility on the patient. He has to push himself and I sure as heck have to push him. Just getting him to school in pain has been the hardest thing that I've ever had to do. But it helps.
And, frankly, surgery and opioids come with their own problems. Sometimes they're the best choice. But don't dismiss the softer stuff you have to do for yourself.
And, frankly, surgery and opioids come with their own problems. Sometimes they're the best choice. But don't dismiss the softer stuff you have to do for yourself.
3
Read Dr. John Sarno. Reputable medical doctor who advises that most lower back pain can be alleviated by you.
7
Sarno wrote about the mind/body connection 40 years ago and no doubt stress can contribute to tense muscles and more pain but many cannot "will" away pain by mindful thinking. However, meditation may help you better cope with the pain.
1
I have been a chronic back pain sufferer for many years. I tried many 'alternative' treatments not covered by my insurance before realizing that narcotic therapy was the only thing that helped. I never take more than the lowest possible dose, and it keeps me mobile and employed. All this "big pharma is out to addict you" is not always the case. As it is being made into some major new 'war on drugs' platform, soon I won't be able to get the medication I need, and most likely become immobile and unemployed. I wish people would stop with the blanket statements.
13
The medication has been scientifically proven over and over again not to work.
Leeches don't cure disease.
Opiates don't heal or treat pain.
People swore by leeches. Opiates are the leeches of our day.
Leeches don't cure disease.
Opiates don't heal or treat pain.
People swore by leeches. Opiates are the leeches of our day.
1
After a lifetime of hard labor, I'd finally suffered my first back injury in an office job at age 38. Frayed carpet caused a chair to flip backwards. A homeopathic chiropractor I'd previously seen could provide service under Workman's Comp.
His title is "chiropractor"; his methods are entirely Eastern. No position was painless. With little progress at 3 weeks, an idea. With gloved hand, he pushed thumb and middle finger firmly to the upper mandible, squeezed hard, tilted my head back, walked me in a circle. CURED. That was in 1998.
Later, a career-related neck issue had arisen. The "robot neck" from a spastic rhomboid had persisted for weeks; driving was difficult, the pain random. The same chiropractor used a knuckle on a pressure point at top of rib cage below armpit. When I sat up, CURED.
This article speaks to the tendency for every pain to be medicated. No drugs were used in either of the above. I have, though, endured other bone pain requiring years of opioids. There are many victims of long-term pain for whom opiates worked in the first few months. Tolerance happens. Increase dose, pain catches up. Repeat. At some point, the process reverses. The more opiates we use, the worse the pain becomes, demanding yet more medicine. Repeat.
Those in such a mess should, quietly, try a few days of lower dosage to test this. From 800 mg/day oxycodone to 480, amazing improvement. Now in 9th year opiate-free; prescribed fluoxetine cured my nerve/bone pain in 4 days.
Happy V-Day!
His title is "chiropractor"; his methods are entirely Eastern. No position was painless. With little progress at 3 weeks, an idea. With gloved hand, he pushed thumb and middle finger firmly to the upper mandible, squeezed hard, tilted my head back, walked me in a circle. CURED. That was in 1998.
Later, a career-related neck issue had arisen. The "robot neck" from a spastic rhomboid had persisted for weeks; driving was difficult, the pain random. The same chiropractor used a knuckle on a pressure point at top of rib cage below armpit. When I sat up, CURED.
This article speaks to the tendency for every pain to be medicated. No drugs were used in either of the above. I have, though, endured other bone pain requiring years of opioids. There are many victims of long-term pain for whom opiates worked in the first few months. Tolerance happens. Increase dose, pain catches up. Repeat. At some point, the process reverses. The more opiates we use, the worse the pain becomes, demanding yet more medicine. Repeat.
Those in such a mess should, quietly, try a few days of lower dosage to test this. From 800 mg/day oxycodone to 480, amazing improvement. Now in 9th year opiate-free; prescribed fluoxetine cured my nerve/bone pain in 4 days.
Happy V-Day!
1
I suffered chronic back spasms and pain for nearly 50 years. Multiple hospitalizations, surgery, injections, PT, massage therapy, exercises, "take off the rest of the week." Nothing really helped the spasms until a kindly DO gave me a short course of Valium. I had no desire to continue taking it once the acute spasms eased up. Thirty-five years ago, my husband learned to do trigger point therapy (myofascial release), and after that he would help by "doing my trigger points," leaning into the small of my back and over my sacrum -- hard -- and then stretching the muscles as they acted up, sometimes 3-4 days a week. But they would periodically go out of control. So it would be back for another short course of valium and advil. But I suffered from back pain at least half the days for all those years. Finally, I was tried on a tiny dose of an SSNRI, although I wasn't depressed about anything but the pain. My pain cleared up in less than a week -- and hasn't returned in any significant way in the two years I have continued on that small dose. It does not mean that all the pain was not real, nor that this is the answer for all or even many sufferers. Just seems that sometimes the problem may be the way our brain chemicals react to the impulses from our hyper-excitable nerves.
People who want to decrease their opiate doses must, must, must talk with their doctor. "Quietly" is dangerous. Doctors are not forcing pills down patients throats. Patients have the right to decide what is best for them. But doctors should instruct patients how to decrease medications so that potential problems can be avoided and patients can be more successful in decreasing their medication use.
1
I'm an emergency physician in Brooklyn. I see comments interpreting these guidelines as "we will now be withholding medications that could make you feel better." This is not true. It is important to understand two points:
One, there is no panacea, no universal modality for chronic pain. We, the healthcare community, have misled our patients through the years to believe that chronic pain can be cured quickly and easily, usually with pills. Exercise, non-opiate alternatives, good mental health practices, and other interventions mentioned here are the best we have right now.
Two, pain medications have little to no benefit for chronic pain. They often paradoxically make pain worse. Opiates, in particular, are horrendously counter-productive for chronic pain sufferers. Opiate dependence and opiate-induced hyperalgesia are far worse than the original conditions for which they were intended.
This is not cruelty or insensitivity. This is our profession finally coming around to the fact that we've been harming our patients for a long time now. This is an important step away from "here, just take this pill," to a more honest discussion about with patients about their chronic pain.
One, there is no panacea, no universal modality for chronic pain. We, the healthcare community, have misled our patients through the years to believe that chronic pain can be cured quickly and easily, usually with pills. Exercise, non-opiate alternatives, good mental health practices, and other interventions mentioned here are the best we have right now.
Two, pain medications have little to no benefit for chronic pain. They often paradoxically make pain worse. Opiates, in particular, are horrendously counter-productive for chronic pain sufferers. Opiate dependence and opiate-induced hyperalgesia are far worse than the original conditions for which they were intended.
This is not cruelty or insensitivity. This is our profession finally coming around to the fact that we've been harming our patients for a long time now. This is an important step away from "here, just take this pill," to a more honest discussion about with patients about their chronic pain.
14
I think you seriously underestimate the number of people--many over 65--addicted to opiates.
No amount of scientific proof will convince them opiates are counterproductive. The gloves come off as soon as anyone threatens their supply.
If the drugs are stopped, the addicts start withdrawal. They confuse this with pain and they refuse to go through the withdrawal to get clean because they like how the drug makes them feel.
They're not pain sufferers; they're addicts.
Your reasoned, proven arguments fall on deaf ears.
No amount of scientific proof will convince them opiates are counterproductive. The gloves come off as soon as anyone threatens their supply.
If the drugs are stopped, the addicts start withdrawal. They confuse this with pain and they refuse to go through the withdrawal to get clean because they like how the drug makes them feel.
They're not pain sufferers; they're addicts.
Your reasoned, proven arguments fall on deaf ears.
1
"No amount of scientific proof will convince them opiates are counterproductive." Perhaps that is because the data is skewed and these people find that opioids do, in fact, help them.
1
My brother Mike had back pain for six months in 2010. His doctor told him to exercise so he got new running shoes and started walking. The pain continued so he saw a massage therapist who recommended physical therapy. He went twice a week and was told to continue the exercises at home which he only did sometimes, making him and us feel he was responsible for his own pain. He finally had a blood test that showed he had bone cancer. He died December 20, 2010. My advice to anyone with persistent lower back pain is to get a blood test and work from there.
135
This is the other major issue. Back pain may have absolutely nothing to do with the back. I also know someone who has passed away from cancer, the first sign of which was four months of debilitating back pain.
3
A familiar story. An employee came in complaining of a sore shoulder one morning. No big deal. We pull voice and data cable and sore muscles and joints are part of the trade.He went to a type of doctor who had him coming in for "adjustments" 3 times a week. After two months he was no longer coming to work. I went out to see him and his arm was in a sling and he needed a cane to walk. I asked my Physical Therapist wife to recommend and Orthopedist and took him in. The Orthopedist sent him for an MRI. It showed tumors growing in his joints. Further testing revealed Non-Hodgkin's Lymphoma which had been metastasizing at a rapid rate. Despite surgery and two bouts of chemotherapy he passed away 8 months later.
He was 30 years old.
I am still angry 17 years later at the first "doctor" who should have referred him out to a doctor as his condition worsened.
He was 30 years old.
I am still angry 17 years later at the first "doctor" who should have referred him out to a doctor as his condition worsened.
6
Completely agree. Light jogging is also good. Get a standing desk. Stretch out in the morning. On bad days use a cane (also good for getting sympathy).
1
" they can try over-the-counter drugs like ibuprofen or aspirin."
NSAIDs are not harmless and for patients with heart disease they can be dangerous. I took naproxen (not for lower back pain) prescribed by an orthopedist and as a direct result developed an ulcer.
These guidelines sound to me like they are driven by a desire to prescribe fewer opioids rather than a desire to treat each patient as an individual with his or her own specific needs. In the "war on opioids," which is currently being waged in the US, the pendulum has swung back and forth, but today there is a strong bias against them that is not necessarily driven by a desire to do what is best for the patient.
One doctor told a patient: "Your inflammatory bowel disease is caused by opioids." The response of a pain management specialist to that claim was: "It sounds like something someone who opposes opioids would say." It seems that every time I read an article about opioid abuse I find numerous questionable assertions, some of which are simply untrue or grossly misleading. Doctors are not always a reliable source of information since they have their own biases, some of which are not based on sound medical knowledge or practice.
I look forward to the day when the pendulum will stop swinging.
NSAIDs are not harmless and for patients with heart disease they can be dangerous. I took naproxen (not for lower back pain) prescribed by an orthopedist and as a direct result developed an ulcer.
These guidelines sound to me like they are driven by a desire to prescribe fewer opioids rather than a desire to treat each patient as an individual with his or her own specific needs. In the "war on opioids," which is currently being waged in the US, the pendulum has swung back and forth, but today there is a strong bias against them that is not necessarily driven by a desire to do what is best for the patient.
One doctor told a patient: "Your inflammatory bowel disease is caused by opioids." The response of a pain management specialist to that claim was: "It sounds like something someone who opposes opioids would say." It seems that every time I read an article about opioid abuse I find numerous questionable assertions, some of which are simply untrue or grossly misleading. Doctors are not always a reliable source of information since they have their own biases, some of which are not based on sound medical knowledge or practice.
I look forward to the day when the pendulum will stop swinging.
16
Cupping worked for me...but the final 'cure' came from reading: Healing Back Pain - the mind-body connection" by John E. Sarno, MD...
2
I am surprised that chiropractic treatment is not mentioned in this informative article.
4
Some people are finding acupuncture helpful. No insurance coverage most of the time, and no Medicare coverage at all. Ditto for yoga, which is supposed to be extremely useful.
The insurance coverage will pay for opioids, which my doctor prescribed. They didn't ease the pain at all. Just made me not care that I was in pain. Months of PT and continuing to do the exercises at home make the pain tolerable.
The insurance coverage will pay for opioids, which my doctor prescribed. They didn't ease the pain at all. Just made me not care that I was in pain. Months of PT and continuing to do the exercises at home make the pain tolerable.
Much of the back, neck and shoulder pain experienced by people is caused or exacerbated by poor postural habits. The average American sits 13 hours each day, and slumps badly while sitting; this harms the spine and also impairs breathing, digestion and circulation.
The Alexander Technique is an educational process that teaches people to see their own poor habits and to stop engaging in those habits. Alexander students learn healthier, easier and more enjoyable ways of sitting and moving about. With the AT, injuries can be prevented and people can regain function and mobility.
If you're having back, neck or joint pain and want to learn how to help yourself, please consider studying the Alexander Technique. There's a free introduction to the AT the first Monday of each month at the American Center for the Alexander Technique in NYC -- check out the AT and see for yourself!
The Alexander Technique is an educational process that teaches people to see their own poor habits and to stop engaging in those habits. Alexander students learn healthier, easier and more enjoyable ways of sitting and moving about. With the AT, injuries can be prevented and people can regain function and mobility.
If you're having back, neck or joint pain and want to learn how to help yourself, please consider studying the Alexander Technique. There's a free introduction to the AT the first Monday of each month at the American Center for the Alexander Technique in NYC -- check out the AT and see for yourself!
2
I am surprised at how much pain and anger this article causes me after all these years.
At 41 I sustained a back injury. Keeping active for the first month landed me in the hospital. THe pain persisted for four years all varieties of interventions failing to help. I could not work and for the first two years could not care for myself. It was a living nightmare and the worst of it was the abuse from the Drs. When a prescribed treatment failed to have the desired result, I became a bad patient! I finally recovered after most of four years in bed mostly without medication because it didn't work either. I am however grateful that opiates were available when the pain was acute. WHat this article says to me is, "Go away! I don't want to be reminded that I really don't know how to help you." A little humility on the part of Drs. would be helpful for their patients and also themselves. Blaming the patient is abusive.
At 41 I sustained a back injury. Keeping active for the first month landed me in the hospital. THe pain persisted for four years all varieties of interventions failing to help. I could not work and for the first two years could not care for myself. It was a living nightmare and the worst of it was the abuse from the Drs. When a prescribed treatment failed to have the desired result, I became a bad patient! I finally recovered after most of four years in bed mostly without medication because it didn't work either. I am however grateful that opiates were available when the pain was acute. WHat this article says to me is, "Go away! I don't want to be reminded that I really don't know how to help you." A little humility on the part of Drs. would be helpful for their patients and also themselves. Blaming the patient is abusive.
27
I wish that the doctors and specialists could at least inquire what occupation the pain sufferer does. Waiting tables, pounding nails, driving heavy equipment, nursing, etc. can cause serious mobility pain and difficulties.
1
It is hard to imagine that the reporter who wrote this story has ever experienced debilitating back pain.
I had to quit my job (I am a hairstylist) because of back pain, related to a herniated disc that happened while I was running.
When the pain was acute, I could not work, I could not move. I was in excruciating pain. At one point, I was prescribed Tramadol. It did nothing and I stopped taking it. The pain continued for years. I was unable to complete a day of work without being in severe pain. I am back in school, changing careers to a non-physical-labor job.
To be told to "go running" is insulting. It does not begin to address the extreme pain and suffering that goes along with severe back pain. I could not go running. I could not go walking! I was very active and in my 30s, and could only lie flat on my back.
I finally found relief through alternative medicine. These paragraphs are the root of this issue, and are what the article really should have been about:
Medical insurance also contributes to the treatment problem, back experts say, because it does not pay for remedies like mindfulness training or chiropractic manipulations which, Dr. Deyo added, “are not cheap.”
Even if doctors want to recommend such treatments, there is no easy referral system, Dr. Atlas said.
I had to quit my job (I am a hairstylist) because of back pain, related to a herniated disc that happened while I was running.
When the pain was acute, I could not work, I could not move. I was in excruciating pain. At one point, I was prescribed Tramadol. It did nothing and I stopped taking it. The pain continued for years. I was unable to complete a day of work without being in severe pain. I am back in school, changing careers to a non-physical-labor job.
To be told to "go running" is insulting. It does not begin to address the extreme pain and suffering that goes along with severe back pain. I could not go running. I could not go walking! I was very active and in my 30s, and could only lie flat on my back.
I finally found relief through alternative medicine. These paragraphs are the root of this issue, and are what the article really should have been about:
Medical insurance also contributes to the treatment problem, back experts say, because it does not pay for remedies like mindfulness training or chiropractic manipulations which, Dr. Deyo added, “are not cheap.”
Even if doctors want to recommend such treatments, there is no easy referral system, Dr. Atlas said.
5
Several years ago, CMS using the AHCPR wanted to stop having Medicare pay for back surgery for back pain. Because a couple of congressmen had relief from surgery (or so they thought..it may have simply been time, bedrest, and the physical therapy that went along with it), the spine surgery societies and spine surgery equipment makers (e.g. Medtronic among others) lobbied heavily against this recommendation. Further, they pushed to defund AHCPR to prevent future damage to their business model. While this article here is cute and interesting, by failing to see the big picture, it misses why this philosophy will never succeed in a country with for-profit medical care.
This article and some of the commenters really stick in my craw. It totally depends on the cause of your back pain! I have chronic back pain and I was a carpenter all my life plus a runner and also had a farm. My back pain kept getting worse and nsaids did nothing. I finally went to a MD/acupuncturist who told me one leg was 1.5 inches long than the other so build up my shoe.Then went to chiropractor and he concurred but had the wrong leg! I figured I should be breaking even. I then went to a highly recommended masseuse who darn near paralyzed me and made the pain way worse. I finally resorted to seeing a neurosurgeon who first prescribed PT, which I did religiously, and Vioxx, well we know how well that would have gone, and I developed stomach issues making nsaids more difficult. I finally had a surgery that lasted 5 hours and had not just severe stenosis in several vertebrae areas, degenerative discs, but also a torn dura where the nerves had to be shoved back in and wrapped. I still have nerve damage and chronic pain as a result. IF I had kept working/exercising, getting massages etc. I could be in a wheelchair right now! Opioids, if monitored and dosage controlled, can actually be lifesaving. It is all relative to what is causing your pain. These holier than though folks who say they got over their pain by exercising through it or acupuncture, massage are simply lucky !!! How do these same folks deal with a broken arm or is that the same as a strained muscle?
21
My intense daily pain was basically ignored for over 10 years by doctors and specialists. I was given prescriptions for high milligrams of ibuprofen and told to take it 4X daily. So I took these pills for 10 years, which did not really cut the pain. The damage to my liver and potentially other organs is incalculable. I stopped taking them. There's got to be a better way. Who treats their patients without actually taking the time to look harder at a patient's problem(s)? I trust most doctors about as far as I can throw them.
3
The "new" guidelines have been the practice of the MD I saw through decades of episodic incidents of back pain so compromising that simple tasks like putting on shoes or getting into a vehicle were excruciating at best and impossible at worst.
My stomach rebelled against NSAIDs (non-steroidal anti-inflammatory drugs). I was reluctant to use opioids. What worked for me in the past was a couple of days muscle relaxants and bed rest followed by the kinds of physical therapy mentioned in the article. This routine restored me to the capacity to be mostly pain free as I resumed my normal activities.
Now, in my seventies, I have found something better--a routine that not only restores my previous capacities but also has expanded my capacities to beyond anything I have been able to do since I was in my thirties.
Now, I don't have to have the staff at the hardware or pet stores load 40-50 pound bags of stuff into my vehicle. Now, I don't have to wait for the "yard guy" to show up to unload those bags and put them away.
You might say I'm on iron therapy. Below parallel back squats, deadlifts, presses, and bench presses with progressively heavier weights have done it for me.
The "new" guidelines may be all that is appropriate for some patients. However, many patients, once stabilized, will find new life through progressive strength training.
Now, I find that the cure my current incidents of back pain is deadlifts.
My stomach rebelled against NSAIDs (non-steroidal anti-inflammatory drugs). I was reluctant to use opioids. What worked for me in the past was a couple of days muscle relaxants and bed rest followed by the kinds of physical therapy mentioned in the article. This routine restored me to the capacity to be mostly pain free as I resumed my normal activities.
Now, in my seventies, I have found something better--a routine that not only restores my previous capacities but also has expanded my capacities to beyond anything I have been able to do since I was in my thirties.
Now, I don't have to have the staff at the hardware or pet stores load 40-50 pound bags of stuff into my vehicle. Now, I don't have to wait for the "yard guy" to show up to unload those bags and put them away.
You might say I'm on iron therapy. Below parallel back squats, deadlifts, presses, and bench presses with progressively heavier weights have done it for me.
The "new" guidelines may be all that is appropriate for some patients. However, many patients, once stabilized, will find new life through progressive strength training.
Now, I find that the cure my current incidents of back pain is deadlifts.
3
It seems strange to me that if for example we would find that simple grass would give us pain relief, the government would ban simple grass. If opioids work we must not have them. Because addiction is worse than the pain relief you might get. What is wrong with people? If something works then give it to the people. Are we a sadistic society where Grandma and Grandpa needs to live in pain? Please don't answer the sadistic suggestion!
18
Tell your grandparents to take up jogging!
2
I've had 2 kinds of back pain: pulled muscle kind of pain that left me immobile for 2-3 days (could only crawl to bathroom).
Then I had excruciating hip pain on and off for years that radiated down my right leg.
"Hip" pain turned out to be degenerated disc.
My 80 yr old GP prescribed the same treatment for both: a back brace, Advil, gentle core exercises, and old-lady shoes while teaching. My velcro back brace was $30.
Treatment has worked really well.
Then I had excruciating hip pain on and off for years that radiated down my right leg.
"Hip" pain turned out to be degenerated disc.
My 80 yr old GP prescribed the same treatment for both: a back brace, Advil, gentle core exercises, and old-lady shoes while teaching. My velcro back brace was $30.
Treatment has worked really well.
1
A few years ago I had back pain that eventually resulted in sciatica. A yoga instructor friend recommend a set of exercises. It took a bit of time, starting slowly, but eventually the pain disappeared.
The cure, strong core muscles.
The cure, strong core muscles.
1
This isn't really new - I've been dealing with serious spinal issues since the age of 20 (though I was and am active and athletic). I spent the 80s in increasingly excruciating pain, and was told by a dozen physicians that physical therapy and activity (and NSAIDs) were all I needed. Turned out my vertebrae were crumbling in my lower spine, the discs had been pulverized out of existence, and the nerve damage was severe. When I finally found a surgeon who was willing to take the time to understand the details of my problem and perform the necessary 5 hour surgery, I (after a long recovery) was able to live pain free and fully functional for well over 20 years (until I experienced another spinal issue that also required surgery).
It's true that most 'back pain' is muscular (with acute nerve inflammation) and should be managed as described in this article. However, the essential task of physicians is to identify the cases where an anatomical issue is in play and must be taken seriously. Given the management of 'health care' services by insurance companies instead of health care providers, it is increasingly difficult for the average person to find a physician willing to take the time to understand the issues faced by any particular patient.
It's true that most 'back pain' is muscular (with acute nerve inflammation) and should be managed as described in this article. However, the essential task of physicians is to identify the cases where an anatomical issue is in play and must be taken seriously. Given the management of 'health care' services by insurance companies instead of health care providers, it is increasingly difficult for the average person to find a physician willing to take the time to understand the issues faced by any particular patient.
82
Desperate for a doctor like the one you described to treat my more than year-long back pain. What's his/her name?!
Go for a run? In my dreams. If I so much as run for the bus, I'm out of commission and on the heating pad for hours or more.
This article is so overly simplistic as to be worthless.
Go for a run? In my dreams. If I so much as run for the bus, I'm out of commission and on the heating pad for hours or more.
This article is so overly simplistic as to be worthless.
1
This article is callous and cruel; and probably written by doctors who have never had to contend with back pain themselves. For many back pain sufferers, it's hard to walk; never mind running or yoga. "Go back to normal activities"? I'll bet that most pain sufferers wish that were possible, but for many, it's not.
This article is cruel and dismissive.
This article is cruel and dismissive.
21
Having suffered with a herniated disk, I found great relief from acupuncture. It's high time that insurance companies begin to cover this relatively low cost option for people who are living with pain.
3
It is covered in certain states like HI and CA, WA and OR but good luck in MA. Their physician's lobbyist groups are very powerful up on Beacon Hill.
Medicine is a BIG business in MA. They HATE competition. How many medical marijuana shops have opened in the state FIVE years after the people voted for it?
Medicine is a BIG business in MA. They HATE competition. How many medical marijuana shops have opened in the state FIVE years after the people voted for it?
2
Go to a Certified Iyengar Yoga Teacher (IYNAUS.org) for low back care. Here is a research article validating the effectiveness of Iyengar Yoga Therapy on Chronic Low Back Pain: SPINE volume 34, umber 19, pp 2066-2076 2009 Williams et al.
No mention of chiropractors? Kept me pain free for 15 years.
3
That's what I thought! How is Chiropractic care missing form this article?
1
Not all lower back pain is the same. Figuring out which is which is a function of medicine. When to do the figuring is a matter of pain, and it is a matter of costs. Lets hope they get it right.
7
I really enjoyed reading this article! I suffered through terrible back pain not too long ago. After many emergency room visits, and going through changes in Anti-inflammatory medications, I only found relief after I started doing Yoga. Running is an excellent way to exercise, but it might not be the best thing to do with pain in your back, but Yoga is a good start.
1
I am a retired podiatrist and practiced for 39 years. In 1999, I published an outcome study which detailed following medical endpoint lower back pain patients for more than one year. In the final followup (13.9 months average), we reported a 84% cure rate by using custom foot orthotics as the only method of care. It was based on the simple notion that how one walked was responsible. It was totally unrelated to impact shock as classically believed, but rather the weight of each limb as it transitions from stance to swing while walking. Each limb weighs 15% of body weight, and the muscle which act each time the limb starts the ensuing swing motion come directly from the lower back! Considering that average folks take thousands of steps/side/day, then chronic may imply walk related repetitive irritation vs long term lower back issues. The back seems to hurt due to the stresses which are applied to it. When they are removed, remarkable healing can occur.
3
I have had chronic back pain for more than two years now its has become Modic Type 1 which shown in my mri readings. I have found info on a treatment with antibiotics fro 100 DAYS they are using in Europe . I have suggested this treatment I like to try the many doctors in the past two years with the reaction " I never heard about that , oh you just have arthritis!" Really , thanks for wasting my hard earn money ( I do work five days a week and I am not on disability )to tell me that! I have lower chronic pain every day of my life. And someone to tell me to just exercise and take otc medications that the pain will go away to help has NO concept of what real pain feels like.
1
These types of recommendations are fine for those of us who can take the time to "Wait It Out". For the masses of people who are living paycheck to paycheck they need something that will allow them to go back to work. It is frustrating knowing that $25 co-pay and day off of work is already a huge strain on people. You are adding to the Opiate epidemic when you continue to support marijuana prohibition and make sweeping recommendations. Shame on you.
6
It's quite easy for these "experts & authorities" to tell everybody else what to do for back pain but it can vary with the individual.
I was injured during a deployment while in the USMC in 1973. A medical board of Navy doctors recommended a spinal fusion if I wanted to finish my career. My orthopedic doctor at Camp Lejeune told me not to let them touch me, & recommended a regimen of muscle relaxants, core strengthening & stretching. He also told me to try practicing yoga after I received my medical retirement.
After 14 months of following his advice, I was able to throw away my back brace & gradually enter back into normal activities, including martial arts.
Over 40 years later, I'm finally getting to the point where I'll most likely have the spinal fusion surgery recommended in 1974, but the incision will be smaller, the technique more precise & the doctors will have more knowledge about the procedure.
Back injuries & pain should always be treated conservatively initially, with NSAIDs, therapy (TENS, massage,etc.) & stretching. But when the electric feeling starts going down the back of the leg, or a foot starts to drag when walking, it's time for a muscle relaxant like Flexeril in combination with stretching. Naproxen/naproxen are not for long term use, as I found out last May when serious stomach problems resulted from 6 years of medication.
A herniated disk WILL require an MRI, & probably an opiod pain reliever. Back pain is not a one size fits all problem.
I was injured during a deployment while in the USMC in 1973. A medical board of Navy doctors recommended a spinal fusion if I wanted to finish my career. My orthopedic doctor at Camp Lejeune told me not to let them touch me, & recommended a regimen of muscle relaxants, core strengthening & stretching. He also told me to try practicing yoga after I received my medical retirement.
After 14 months of following his advice, I was able to throw away my back brace & gradually enter back into normal activities, including martial arts.
Over 40 years later, I'm finally getting to the point where I'll most likely have the spinal fusion surgery recommended in 1974, but the incision will be smaller, the technique more precise & the doctors will have more knowledge about the procedure.
Back injuries & pain should always be treated conservatively initially, with NSAIDs, therapy (TENS, massage,etc.) & stretching. But when the electric feeling starts going down the back of the leg, or a foot starts to drag when walking, it's time for a muscle relaxant like Flexeril in combination with stretching. Naproxen/naproxen are not for long term use, as I found out last May when serious stomach problems resulted from 6 years of medication.
A herniated disk WILL require an MRI, & probably an opiod pain reliever. Back pain is not a one size fits all problem.
9
Sometimes the pain is due to spinal stenosis. Sucking it up, just won't do.
14
Yet another article on pain treatments that does not mention light therapy. Red and infrared light therapy devices are safe, inexpensive, FDA approved and, according to published research, very effective for relieving nerve and muscle pain. When will NYT report this?
2
This is just one doc's observation, but perhaps other primary care physicians have similar thoughts. Since the CDC and many other health institutions said, out loud, that opioids (derivatives of the poppy) are over prescribed and that they are not effective for chronic pain, I see very few patients who expect these controlled substances for back pain. Of course, they could be going to other clinics, but then I've always been very sparing of opioids scripts without any change in the almost every other day patient who comes, expecting these medications.
So I'm wondering what is the natural history of acute back pain and how much of patient expectation is shaped by community perceptions of this very common ailment.
And I wonder whether the huge toll of work absences and disabilities due to back pain have changed since we no longer consider pain to be the fifth vital sign.
So I'm wondering what is the natural history of acute back pain and how much of patient expectation is shaped by community perceptions of this very common ailment.
And I wonder whether the huge toll of work absences and disabilities due to back pain have changed since we no longer consider pain to be the fifth vital sign.
I suffered from back pain for more than 25 years. It happened the first time at age 25 as a result of my Karate practice. After many years I have finally solved the problem and learned to maintain my back. I had gone to chiropractors, Yoga people and massage therapy and NO ONE could help me..plainly stated: It seems no one understand how to heal the lower back. But, I do! And it is called the "Lower Lunge". I have helped numerous people relive their pain and keep it away with proper stretching.
This is not woo woo..it is because the hip flexor tightens and this causes other parts to pull down clipping the nerves...giving pain! Instant relief if not improvement is available. Literally!
All Dr's want to do is prescribe medicine or cut you up.
This is not woo woo..it is because the hip flexor tightens and this causes other parts to pull down clipping the nerves...giving pain! Instant relief if not improvement is available. Literally!
All Dr's want to do is prescribe medicine or cut you up.
3
These guidelines are too broad. I suffer from ankylosing spondylitis, which is an autoimmune/autoinflammatory arthritis that primarily affects the spine. To diagnose it in the early stages, when treatment with biologic medications can prevent permanent damage to the spine, an MRI of the sacroiliac joints with contrast is often necessary. AS is a chronic pain disease that is frequently mis-diagnosed in this country. It takes, on average, 8-10 years for a person suffering from AS to be accurately diagnosed, and I fear this problem will only get worse if these guidelines are implemented.
7
I had chronic lower back pain for many years. Once I bent to pick up a petunia and my back went out and I couldn't walk! Over the past few years I have had a daily yoga practice, just 15 minutes every morning and have not had any more pain. That combined w massage when I'm working and can afford it and an occasional naproxen and I'm good to go. A good yoga class is not expensive and many community centers offer it for free. I have also learned to get up and stretch regularly sometimes setting a timer when I'm working. The upper thoracic pain however did involve expensive physical therapy that was not covered by insurance. It's called myofascial release and the painful concrete block that I had for years is gone. I do wish that insurance covered these therapies as my job is physically demanding and I can't work without them.
2
As an emergency physician and chronic back pain sufferer since age 14, I don't have a single shift where I don't see a patient with acute, chronic, or acute-on-chronic back pain. The evaluation is straightforward: ask what happened, ask about back pain "red flags" that suggest something more sinister than run-of-the-mill back pain, and essentially give them a similar spiel to the one in the article.
I used to try everything, earlier in my career: opiates like vicodin or percocet, anti-inflammatories like motrin or aleve, valium for muscle relaxation, a numbing pain patch over the area that hurt, and an ice pack or heat pack. I'd come back into the room, invariably wake the patient up (drowsy from all the medicines I'd tried), and just as invariably hear that they're still having significant pain. Then I'd say, "Sorry, I don't have any other options," and send them on their way with prescriptions (helping them get up from the stretcher that they'd gotten stuck in due to pain).
Nowadays, I spend much more time educating than I do prescribing. Sit down with the patient, talk about back pain expectations, give them a prescription for ibuprofen, and send them on their way. "Stay active. Don't go run, but get out of bed. Get dressed. Make lunch. Basic normal things."
No medicine works well for back pain besides time. Honestly, I wish I had something that helped — I don't like being a physician and not having a fix. Throwing opaites at this are what got us into this mess.
I used to try everything, earlier in my career: opiates like vicodin or percocet, anti-inflammatories like motrin or aleve, valium for muscle relaxation, a numbing pain patch over the area that hurt, and an ice pack or heat pack. I'd come back into the room, invariably wake the patient up (drowsy from all the medicines I'd tried), and just as invariably hear that they're still having significant pain. Then I'd say, "Sorry, I don't have any other options," and send them on their way with prescriptions (helping them get up from the stretcher that they'd gotten stuck in due to pain).
Nowadays, I spend much more time educating than I do prescribing. Sit down with the patient, talk about back pain expectations, give them a prescription for ibuprofen, and send them on their way. "Stay active. Don't go run, but get out of bed. Get dressed. Make lunch. Basic normal things."
No medicine works well for back pain besides time. Honestly, I wish I had something that helped — I don't like being a physician and not having a fix. Throwing opaites at this are what got us into this mess.
82
Please share the "red flags" that indicate a more serious condition.
Would be happy to see you in my office and evaluate for potential treatments. I currently work at Chiromedical group in the embarcadero center. We offer PT, chiropractic, and I do regenerative injections for healing ligaments and tendons that are often the main pain generators.
I had a friend who was a public works director. He got down in a ditch to join his workers one day and severely wrenched his neck. As non-pharmacological measures largely failed, he spent the next six months unable to work and forced to sleep in the living room recliner for neck support.
Fortunately he had a good doctor, a humane doctor, a common sense and compassionate doctor. This doctor prescribed time -- and gentle P.T. -- for the muscles and nerves to heal. Meanwhile, this doctor also realized that this was a man in need of relief, not out for drugs. The doctor saw human suffering, not weakness or criminality. He prescribed opiod medicines and patience.
After half a year of following this treatment, my friend got off the medicine, the P.T. and the recliner. He returned to work, his bed and a normal life. He never suffered from addiction, and the humanity shown him by not dismissing his pain as an "annoyance" is what helped keep him on an even mental keel. Meanwhile, the pills he didn't take went into a basket, which sat on a high shelf and served as a reminder about the good that the medical profession can provide.
Fortunately he had a good doctor, a humane doctor, a common sense and compassionate doctor. This doctor prescribed time -- and gentle P.T. -- for the muscles and nerves to heal. Meanwhile, this doctor also realized that this was a man in need of relief, not out for drugs. The doctor saw human suffering, not weakness or criminality. He prescribed opiod medicines and patience.
After half a year of following this treatment, my friend got off the medicine, the P.T. and the recliner. He returned to work, his bed and a normal life. He never suffered from addiction, and the humanity shown him by not dismissing his pain as an "annoyance" is what helped keep him on an even mental keel. Meanwhile, the pills he didn't take went into a basket, which sat on a high shelf and served as a reminder about the good that the medical profession can provide.
8
As someone who suffered from sometimes debilitating lower back pain for much of his adult life, my suggestion is - experiment with your mattress! That is the only thing that did it for me, though I was in my fifties when I finally hit upon the right one after a half dozen changes over two years.
2
The article states: "Those taking the placebo [that they knew was a placebo] reported less pain and disability than those in the control group who did not take it. The placebo effect, although modest, was about the same as the effect in studies testing nonpharmacological treatments for back pain like acupuncture, massage or chiropractic manipulations." Which suggests that all of these treatments are due to placebo effects. And if these other treatments are expensive -- because they are not covered by insurance, nor should they be as placebo woo -- or difficult to refer patients to, why not just use a placebo pill? It's cheap and just as effective! Even when the patient knows it's a placebo.
1
Right. I occasionally have a backache and treat it with mild exercise and a heating pad. Never taken over-the-counter or prescriptions.
1
My back pain is completely gone since I ignored my (ex-) doctor's advice to just take advils for what he thought was a 'wear + tear'.
I was sure it was a mix of poor posture at my computer + lugging my (then small) children around.
I did Yoga + especially positions that bend my spine backwards helped within a few weeks (and try to avoid a laptop slump). I am glad this article promotes a conservative approach to medication.
I was sure it was a mix of poor posture at my computer + lugging my (then small) children around.
I did Yoga + especially positions that bend my spine backwards helped within a few weeks (and try to avoid a laptop slump). I am glad this article promotes a conservative approach to medication.
1
I had chronic lower back pain for years that got worse and worse up to the point being taken to hospital in ambulance.
I lucked into finding that lifting weights, losing some weight, and exercising over the last 30 years has make my back pain free for the last 25 years. By the way I hate to lift weights and don't much like exercise, but really suffered from the severe back pain. I found that it is important to lift at a level I found somewhat painful--at least hard-- and do exercises that strengthen my back. The one that works best for me is lean back against heavy weight while setting on the weight machine. This is a common weight machine in most gyms. Yes it did take 3 to 5 years before most of the pain went away, but at 70 I now can and do play basketball with teenage basketball players
I lucked into finding that lifting weights, losing some weight, and exercising over the last 30 years has make my back pain free for the last 25 years. By the way I hate to lift weights and don't much like exercise, but really suffered from the severe back pain. I found that it is important to lift at a level I found somewhat painful--at least hard-- and do exercises that strengthen my back. The one that works best for me is lean back against heavy weight while setting on the weight machine. This is a common weight machine in most gyms. Yes it did take 3 to 5 years before most of the pain went away, but at 70 I now can and do play basketball with teenage basketball players
1
As someone who has lived with lower back pain for over 30 years, I generally agree with this article. I have found that while reestablishing at least gentle movement is critical in the short term, it is also important to modify one's normal routine to accommodate a fragile back.
Although, I do suffer from chronic back spasms, arthritis, spinal compression and sciatica, I generally have been able to control my symptoms quite effectively with stretching, strength training, NSAIDs (for arthritis), icing, semi-regular visits to my chiropractor and by replacing running with swimming as my primary form of exercise. Not easy, but effective.
Although, I do suffer from chronic back spasms, arthritis, spinal compression and sciatica, I generally have been able to control my symptoms quite effectively with stretching, strength training, NSAIDs (for arthritis), icing, semi-regular visits to my chiropractor and by replacing running with swimming as my primary form of exercise. Not easy, but effective.
3
I find it kind of amazing that when something as benign as "a walk" is suggested people say, "I couldn't possible do that." But when a doc suggests cutting you open and maybe putting you back together better or alternativeely taking a drug that is highly addictive, people say, "Yes, sign me up!"
1
After years of avoiding my MD's suggestion of cutting me open and putting me back together for my pain, I finally agreed when it looked like I'd have to go to a wheelchair. Immediately after the surgery, THAT pain was gone. The incision pain only lasted a few days. Frankly, I should have had the surgery the first time it was suggested; it would have saved me 6 years of suffering. But then, my doc said he can only help 15% of people that way; I happened to be one of them. Not everyone gets offered the surgery.
1
While I do not believe that opioids are the best treatment for back pain or better than ibuprofen, your advocacy of not diagnosing is frightening. Back pain can be the result of serious problems.
13
Trigger points in the lower back will heal when the area is relaxed. The key to that is always providing lower back support that your lower back can relax into and then consciously relaxing it into that support -- a small pillow, pad or car seat lumbar support. Be aware of tension in the lower back and always act immediately to allow it to relax.
I suffered my first lower back pain at age 18 after sitting for a long time in an old chair with a collapsed seat. I had been unconsciously tightening my lower back to hold my butt up out of the seat. Prolonged tightening produced spasms of the muscle and painful trigger points. I think this is a common sequence of events.
After years of off and on back pain, I came up with these solutions:
1. Always use lower back support. Consciously relax the back into it.
2. Hang from an overhead bar after stressing the lower back.
3. Avoid static stretching of sore muscles -- gentle movement only.
4. Strengthen lower back by use of the "Roman chair" device in the gym. Start this only when out of pain, with few reps, then work up the reps very slowly and continue the exercise forever.
Using these methods, I have stayed away from any significant back problems for 30 years.
I suffered my first lower back pain at age 18 after sitting for a long time in an old chair with a collapsed seat. I had been unconsciously tightening my lower back to hold my butt up out of the seat. Prolonged tightening produced spasms of the muscle and painful trigger points. I think this is a common sequence of events.
After years of off and on back pain, I came up with these solutions:
1. Always use lower back support. Consciously relax the back into it.
2. Hang from an overhead bar after stressing the lower back.
3. Avoid static stretching of sore muscles -- gentle movement only.
4. Strengthen lower back by use of the "Roman chair" device in the gym. Start this only when out of pain, with few reps, then work up the reps very slowly and continue the exercise forever.
Using these methods, I have stayed away from any significant back problems for 30 years.
3
These suggestions are fine for muscular pain. What if one has spinal stenosis? What if you were born with curvatures in your spine that put undue pressure on your discs or impinge on your nerves? What if you were in a car accident and fractured your spine, though not badly enough to need surgery? I've experienced all these issues and a few more. Most days I am fine--just mild to moderate back pain that can be relieved to some degree with stretching or heat. Exercise helps. But some days I cannot get out of bed without excruciating pain and need help getting on my pants. Anything other than standing and shuffling around brings intense pain. I am grateful my physician trusts me with small amounts of prescription pain relief for these events.
3
I do not have a weak back. I carried several tons of dirt and rock. one bushel basket at a time, to build raised garden beds. When I hurt my back (at work), it's been astonishing how much it has limited my life. Ibuprofen is the only thing that helps. Don't say cavalierly "go back to your normal activities" when unloading a dishwasher or simply making a bed causes pain.
7
As an LMT, I found this article a bit bizarre. "Why not go for a run?" "Why not return to your normal activities?" Well, the normal activities and the normal state of being are what resulted in back pain in the first place, so returning to them while still in severe pain is curious advice.
In my experience, there are many forms of movement and strength-based approaches to resolving back pain that clients can learn, but they do have to learn new skills and follow through with their exercise on a near-daily basis until their bodies adapt. Otherwise, while the back pain may initially subside, as soon as they go back to full activity, it is likely just to result in a reoccurrence.
Obviously, I believe massage therapy can play a role in reducing back pain, but I refer almost all clients with back pain to a PT, pilates instructor, or movement-based practitioner of their choice. Not surprisingly, not many follow my suggestion, but I've done my bit...the rest is their responsibility.
In my experience, there are many forms of movement and strength-based approaches to resolving back pain that clients can learn, but they do have to learn new skills and follow through with their exercise on a near-daily basis until their bodies adapt. Otherwise, while the back pain may initially subside, as soon as they go back to full activity, it is likely just to result in a reoccurrence.
Obviously, I believe massage therapy can play a role in reducing back pain, but I refer almost all clients with back pain to a PT, pilates instructor, or movement-based practitioner of their choice. Not surprisingly, not many follow my suggestion, but I've done my bit...the rest is their responsibility.
56
Let's all calm down a bit here. For years the public has been clamoring that doctors have been too aggressive treating run-of-the-mill pain complaints with medications, procedures, and surgery. Now the American College of Physicians recommends a very reasonable, conservative strategy of stretching and OTC NSAIDs as first line therapy for acute lower back pain without radicular symptoms, and the doctors suddenly "don't care about my pain."
I'm sorry - aches, sprains, and pains are a normal part of life and do not need to be treated with opioids or steroid injections. There was a time not too long ago when opioids were ONLY prescribed for two conditions: acute post-operative pain and cancer pain with a relatively short life expectancy. There's a role for opioids and surgery, but they're jumped to far more quickly in America than Europe or the rest of the world. Time to toughen up a bit.
I'm sorry - aches, sprains, and pains are a normal part of life and do not need to be treated with opioids or steroid injections. There was a time not too long ago when opioids were ONLY prescribed for two conditions: acute post-operative pain and cancer pain with a relatively short life expectancy. There's a role for opioids and surgery, but they're jumped to far more quickly in America than Europe or the rest of the world. Time to toughen up a bit.
1
Bad advice. I have a relative that had back pain persist, finally went for an MRI (because she insisted) and was diagnosed with leukemia.
1
Lose weight, best thing to do for the back and the knees.
2
I don't believe running is good for your long-term well-being, period - let alone if you have a bad back. I'd rather ride a bike, or go for a swim.
3
When my "back goes out" from lifting something wrong, I have found a wonderful family physician who practices osteopathic manipulations. I kid you not-- I go from hobbling into the office to leaping off the table. No more sitting around for a week with an ice pack!
I have ruptured disks, osteoarthritis in my spine and neck and fibromyalgia. These often result in considerable pain. On the advice of my rheumatologist, I take acetaminophen only. On a really bad day, I take one naproxen. But walking is best. Keeping active keeps the pain down. It also makes me happier. Acute pain will generally go away. Why waste time and money on 'treatments' that don't work? On the other hand, if one has pain running down the leg, then one should see the doctor to avoid nerve damage. But opioids should be used only when other treatments fail. I will always remember what my orthopedist said to me years ago after a neck injury,"You are too smart to have surgery."
1
Yes, exercise is something all adults with back pain should do. But what about those of us who exercise on a regular basis I'm an avid runner and I Crossfit. Exercise has not helped the tear and the stenosis in my lower back. In fact, I'm at a point where I can't run a mile (I love the half marathon distance (14) and have run 2 marathons.) The pain is instant but I run through it to at least get a mile in. I've tried physical therapy, chiropractic care and I've had a steroid injections. I've taken a break from both forms of exercise in the hopes my back would heal. It hasn't. So I continue to exercise 5 to 6 days a week and do what my back will allow that day, I replaced rowing for running, for now. But I do want to get back on the road for the spring. So I'm having an anesthetic injected in the spot that hurts the most and if it works I've going to have Radiofrequency Ablation because I need to stay active at this old age of 61.
1
As a physician who had major thoracic spinal trauma, and went through the entire process of spinal rehab and etc., (and am grateful for health insurance and very skilled clinicians) I too realize that what I need to adjust to at my age is restricted mobility, restricted heavy lifting, less gardening and snow shovelling, and thus forth.
Big Pharma and the current mind-set is to provide a "pill for every ill" attitude amongst physicians, patients, alike.
Drugs are needed on an acute basis. When chronically administered for musculo-skeletal pain, there is emerging knowledge that they can do more harm than good.
Let us welcome inexorable aging as a friend and adapt to it!
Big Pharma and the current mind-set is to provide a "pill for every ill" attitude amongst physicians, patients, alike.
Drugs are needed on an acute basis. When chronically administered for musculo-skeletal pain, there is emerging knowledge that they can do more harm than good.
Let us welcome inexorable aging as a friend and adapt to it!
Anyone and everyone with back pain should read "Healing Back Pain" by Dr. Joe Sarno. He's a lead doctor at Cornell Weill in NYC. Pro sports teams and orchestras use this method which is based on the idea that the vast majority of back pain is psychological. I am a biologist, and as such was skeptical. But it really works. Also see the 60 Minutes segment on the approach.
Anna
Anna
1
We can't find the cause, so it's all in your head...sounds like the way mental health used to be treated...and sometimes still is...
That's not to say that some of it isn't psychological, but the vast majority? I don't think so.
That's not to say that some of it isn't psychological, but the vast majority? I don't think so.
My 94 yo dad suddenly got shooting pains in his lower back and couldn't stop screaming. We did start him on oxy, but the side-effects were so terrible that we discontinued it a few days later and replaced it with the following: 1) low dose naproxen twice a day, 2) lidocaine back patch (each day for 12 hours) 3) TCH gummies at night and in the morning. The gummies allowed him to sleep (better then ever) and it took the edge off the pain. And there were no side-effects. This intense pain started about 4 weeks ago. Today, he is not quite back to himself but he has resumed some walking (he completely stopped with the onset of the pain) and I see him beginning to enjoy life again. Of course the pain is not gone, but we are managing it successfully. I encourage people with this kind of intense back pain to be as creative as possible in looking for solutions that do not involve narcotics.
1
So MRI scans can show "what look like abnormalities that actually are not related to the pain." Heaven forbid clinicians gather data they cannot understand.
"Dr. Standaert told [a patient] an M.R.I. would not make any difference in her diagnosis or recovery...". Wow. The man was able to divine that by gazing into space. Ingenious.
God help us. Does not the medical profession understand the concept of addressing causes?
"Dr. Standaert told [a patient] an M.R.I. would not make any difference in her diagnosis or recovery...". Wow. The man was able to divine that by gazing into space. Ingenious.
God help us. Does not the medical profession understand the concept of addressing causes?
2
Very mixed feelings about this article. Mike from Urbana expressed much of my feelings and experience. I'd just say to the doctors who say "tough it out" (that's what it amounts to), try to walk a mile in my shoes when I can barely stand up. Really. Yes, it will pass on its own. Stay in bed for a couple days. Fine - what do I tell my boss? Hey, boss, I'm going to use all my personal days this year, please don't fire me. That is the reality many people face - I've been there, done that, and had to sue. The process of the lawsuit took two years. I had to go on welfare. I got thrown out of a VA hospital as my injury was not combat-related (I am a vet).
I don't want to downplay the problems with opioids. But I think Mike from Urbana did put a little perspective on it.
I don't want to downplay the problems with opioids. But I think Mike from Urbana did put a little perspective on it.
2
I had problems with my back all through the holidays. I was in agony.
Then I did two things that seemed to CURE it:
1. I went to the Women's March in Washington and stood around for hours and hours, and marched for hours, and my back felt great.
2. Shoveled snow. Lots of snow.
Don't ask me, I don't understand it either. But you could try it!
Then I did two things that seemed to CURE it:
1. I went to the Women's March in Washington and stood around for hours and hours, and marched for hours, and my back felt great.
2. Shoveled snow. Lots of snow.
Don't ask me, I don't understand it either. But you could try it!
1
This certainly is good information and goes a long way in updating the medical profession and patients in uncomplicated low back pain. This should not give patients the false impression that they can self treat without receiving a diagnosis from their physician. As an Orthopedic Surgeon there are many causes of low back pain that are much more serious that may first present as "uncomplicated". Causes such as infection, malignancy, kidney disease must be investigated thoroughly.
2
I find it amazing that these practitioners advocate chiropractors, acupuncture and yoga. While there is nothing wrong with any of these treatments per se, there is no good evidence that they are effective in the treatment of lower back pain. Most studies have either been underpowered or failed to show any beneficial effect whatsoever. NSAIDs do relieve pain and can help maintain mobility and are relatively safe, if appropriate precautions are taken. Cortisone injections are appropriate for many patients with chronic pain. Surgery in select indications can prevent permanent disability and loss of function. I am afraid that the attitudes and suggestions in this article may lead many physicians to improperly dismiss symptoms that need to be evaluated fully before telling patients to "go run". The latter is one of the most cavalier and ignorant statements I have heard a physician make. As for those who have incurred acute trauma as the young woman described, pain two weeks after a fall needs to be evaluated further than merely being told to keep active. Presumably she at least received a complete and thorough physical exam that convinced the physician there was no fracture or other injury that should have led to tailored therapy even if it did not require surgery. I am afraid these guidelines are likely to lead to a small percentage of patients who will be improperly diagnosed and suffer permanent disability by not getting appropriate evaluation and therapy.
10
If your back pain is due to stenosis, run, don't walk, from chiropractic treatment. This treatment works great under some circumstances, but for this condition it will only make things much, much worse. Speaking from experience here. Yes, anecdotal, but backed up by my physicians.
2
Often acute pain simply cannot be relieved in a timely fashion by OTCs and non pharmacologic methods. It is disconcerting and seems cruel to deprive patients of opioids since they do work.
6
I have had on and off lower back pain for years. Waiting it out has always worked, with one proviso. To maintain any semblance of normal life, you have to mitigate the pain. So I used lidocaine patches. Their great virtue--you are not taking pain killers by mouth that travel through your system causing nasty side effects and eventually leading to addiction. The patches just numb the pain for a few hours. In its infinite wisdom, Medicare decided they were no longer going to cover the patches. Now a 90 day supply costs over $500. Opoids still $10 a prescription.
4
Get a hip X-ray! My very fit husband suffered serious back pain for 1 1/2 years, consulting with numerous spinal doctors, most recommended back surgery. Finally a chiropractor watched him walk and said "It's your hip." So we learned about "referred pain," he had a hip replacement and pain disappeared. Pretty sad that so few surgeons can look at the whole picture.
3
As a specialist treating low back pain every day, I know that the causes of low back pain can be anything from a subluxed vertebra to a herniated disc or a strained muscle. These all require different treatments. More importantly, there are underlying causes that are unique to each individual like a weak core or gluteus medius tendinosis inhibiting firing of the muscle in the hip that supports the low back.
As an osteopath, I assess for these with my hands like a chiropractor would. As a musculoskeletal sonographer, I evaluate the ligaments and tendons in the area of pain. As a regenerative medicine doctor, I can use growth factors derived from the patient's blood to accelerate the healing in areas that don't heal as well on their own and can become the source of chronic low back pain like ligaments. As an acupuncturist, I can work on the larger strain patterns in the body and release tension and relieve pain non pharmacologically. As a yoga therapist, I can teach patients how to strengthen the muscles that aren't working correctly without setting them up for further injury like may happen if I were to just send them out 'to run' or to a yoga class.
None of the above are taught in medical school. I do this everyday, all together and utilizing any of these modalities given the presenting signs and symptoms, which I evaluate like a conventional doctor would by looking at sensation, strength, reflexes and special tests. Medications and steroids have their place as well
As an osteopath, I assess for these with my hands like a chiropractor would. As a musculoskeletal sonographer, I evaluate the ligaments and tendons in the area of pain. As a regenerative medicine doctor, I can use growth factors derived from the patient's blood to accelerate the healing in areas that don't heal as well on their own and can become the source of chronic low back pain like ligaments. As an acupuncturist, I can work on the larger strain patterns in the body and release tension and relieve pain non pharmacologically. As a yoga therapist, I can teach patients how to strengthen the muscles that aren't working correctly without setting them up for further injury like may happen if I were to just send them out 'to run' or to a yoga class.
None of the above are taught in medical school. I do this everyday, all together and utilizing any of these modalities given the presenting signs and symptoms, which I evaluate like a conventional doctor would by looking at sensation, strength, reflexes and special tests. Medications and steroids have their place as well
3
This is a crock of you know what...I have a nerve-damaged, weakened right leg thanks to "conservative medicine" and the refusal to do an MRI which would have shown the disc material crushing my femoral nerve...only after my leg literally collapsed under me did they finally do an MRI and then the surgery. As a result I had to learn to walk again costing me and the insurance company $50k-plus in rehab and physical therapy. This could have been prevented. Huge curses on the PA and doctors who delayed the MRI until after the damage was done...
3
I hurt my back years ago carrying my toddler on a walk. I had forgotten her Ergo and was holding her in my arms.
Days later my lower back was in a lot of pain. I tried squatting and curving my lower back in the opposite direction.
My friend spotted me and advised me instead to lie on the floor on my stomach and gently prop myself up on my elbows for 5 to 10 minutes per day. "It's a gentle stretch," she said. "Don't force anything."
She said a friend of hers from the National Park Service who had ruined his back after years on trail crews had discovered it after years on disability and after making the desicion to have surgery.
For me (and her other friend) it has worked like magic.
I find, now that I am 47, that I am capable of injuring myself just in the process of waking up, even though I am active and I run and have a job that requires me to stand all day.
That mild positional stretching exercise for my back is protective, however. I do it every night before going to bed.
Days later my lower back was in a lot of pain. I tried squatting and curving my lower back in the opposite direction.
My friend spotted me and advised me instead to lie on the floor on my stomach and gently prop myself up on my elbows for 5 to 10 minutes per day. "It's a gentle stretch," she said. "Don't force anything."
She said a friend of hers from the National Park Service who had ruined his back after years on trail crews had discovered it after years on disability and after making the desicion to have surgery.
For me (and her other friend) it has worked like magic.
I find, now that I am 47, that I am capable of injuring myself just in the process of waking up, even though I am active and I run and have a job that requires me to stand all day.
That mild positional stretching exercise for my back is protective, however. I do it every night before going to bed.
Mothers can carry a lot of disproportional pain by constantly carrying their kids, lifting their car seats in and out of cars and hauling their gear around.
Yes, I know Dad's do some heavy lifting too but not as constant as the mother who just went through labor remember. The muscular and skeletal systems of new mothers are vulnerable and often still healing.
Yes, I know Dad's do some heavy lifting too but not as constant as the mother who just went through labor remember. The muscular and skeletal systems of new mothers are vulnerable and often still healing.
"for most of the people with acute back pain — defined as present for four weeks or less that does not radiate down the leg — there is no need to see a doctor at all"
What about people whose pain lasts longer than 4 weeks and DOES radiate down the leg?
What about people whose pain lasts longer than 4 weeks and DOES radiate down the leg?
DOCTOR JOHN SARNO. It took me five years, but I have NO pain at all and can do everything I want - from backpacking to mountain biking to yes, even moving boxes. My pain was a consistent 7 for years and years, I didn't want to live anymore. Without Sarno, I could very well still be in it.
Read his books, commit to his program. Be patient.
Read his books, commit to his program. Be patient.
2
One thing to remember is that a great way to approach back pain is to "treat" it before it occurs. Attention to posture, remaining active and maintaing a healthy diet set us up for swift recovery when the unexpected happens.
On the other hand, my daughter thought she had broken/injured her tailbone and read somewhere that nothing could be done medically and she would have to wait for it to heal. However, it did not. Come to find out it was a pilonidal cyst and she needed minor surgery to clean it out. The surgeon embarrassed her by pointing out that it was unusual for a teenager to have such a condition (unlike truck driver's "whose hairy butts go jouncing about"), but had just gone and had it checked, she would have been saved a great deal of unnecessary pain. It's great that doctors are being given these guidelines, but sometimes it's better to have a doctor tell you it's nothing and prescribe yoga. As the doctor points out in the article, sometimes you don't know and just being told it will get better is enough.
With DO's (Doctors of Osteopathic Medicine) now making up a quarter of new medical graduates, it is an oversight for these guidelines to omit the potential benefits of osteopathic manipulative medicine in low back pain. OMM has been shown to be at least equivalent to the standard of care in managing chronic low back pain, is included in the ICD10 billing framework, and is often covered by insurance. Though DOs can be found in every specialty and most hospital networks, there seems to be a relative lack of awareness among both patients and MD-credentialed physicians as to the practice and benefits of manipulative medicine.
1
I hate it when my husband is (always) right, but not enough not to send this link to him and tell him that I will stop nagging him about going to the doctor.
The new guidelines seems more like a response to the opioid hysteria we see in the media than a scientific study. I am a chronic back pain sufferer (15 years). Ironically running marathons and being a gym rat for 30 years may have contributed to the cause of my back issues. I am age 64. I have been in a controlled and highly reputable pain management treatment program for 10 years.
The program does not allow self-referral. You must be referred by your GP. Before referral I spent 5 years of going through physical therapy including acupuncture, meditation and chiropractic therapy - to no avail. Additionally, I receive steroid epidurals & I have a neurostimulator implanted in my back which produces amazing results. I have done meditative yoga and tai chi every day for 10 years and yes I take low doses of opioid medicine. My pain is greatly reduced by these methods.
I read of alleged epidemic of death from heroin or Fentanyl. Those drugs are never prescribed & are taken as a choice. It's not because they were once treated for pain with Vicodin and then became addicted. It's because they enjoyed the euphoria and sought more of it turning to illegal heroin. This is a psychological not a physical issue. Don't throw the baby out with the bathwater because people choose heroin to get high. In a controlled medical environment such as I am in no one is addicted, no one turns to illegal street opioids and people receive wonderful treatment for their chronic back pain.
The program does not allow self-referral. You must be referred by your GP. Before referral I spent 5 years of going through physical therapy including acupuncture, meditation and chiropractic therapy - to no avail. Additionally, I receive steroid epidurals & I have a neurostimulator implanted in my back which produces amazing results. I have done meditative yoga and tai chi every day for 10 years and yes I take low doses of opioid medicine. My pain is greatly reduced by these methods.
I read of alleged epidemic of death from heroin or Fentanyl. Those drugs are never prescribed & are taken as a choice. It's not because they were once treated for pain with Vicodin and then became addicted. It's because they enjoyed the euphoria and sought more of it turning to illegal heroin. This is a psychological not a physical issue. Don't throw the baby out with the bathwater because people choose heroin to get high. In a controlled medical environment such as I am in no one is addicted, no one turns to illegal street opioids and people receive wonderful treatment for their chronic back pain.
4
OK, I get it. A tiny percentage of short-term medical opioid users may be subject to becoming long-term abusers. Just like some treatments options can result in death or disability, there can be bad outcomes. Yet, no one is suggesting that a vast range of medical services be withheld from the public.
As someone who has had back pain ignored or downplayed, only to find out later there really is something bad going on, I was heartened by the increased attention to patient suffering in recent years. That seems to be swept away by the moral imperative to avoid creating more addicts. So what about the pain needs of the 98% of us who will NOT become addicts? Tough, your suffering doesn't rate any longer.
In fact, the new guidelines seems a lot like those I've noted for another medical troublespot -- workers injured on the job. For several decades, medical treatment for workers seems focused on convincing employees they're not hurt, just malingering. The patient? That's your boss, whose financial interest in you not being officially "injured" outweighs the worker's need for medical treatment.
Then there's OSHA, long ago blocked from developing effective standards to limit on the job back injuries.
Doesn't matter how you hurt, you will be left suffering - for your own good. Oddly, your Dr. will still send you for various treatments that might kill or injure you, but many now don't want to take the remote chance on you liking your suffering relieved. Why bother? Heroin anyone?
As someone who has had back pain ignored or downplayed, only to find out later there really is something bad going on, I was heartened by the increased attention to patient suffering in recent years. That seems to be swept away by the moral imperative to avoid creating more addicts. So what about the pain needs of the 98% of us who will NOT become addicts? Tough, your suffering doesn't rate any longer.
In fact, the new guidelines seems a lot like those I've noted for another medical troublespot -- workers injured on the job. For several decades, medical treatment for workers seems focused on convincing employees they're not hurt, just malingering. The patient? That's your boss, whose financial interest in you not being officially "injured" outweighs the worker's need for medical treatment.
Then there's OSHA, long ago blocked from developing effective standards to limit on the job back injuries.
Doesn't matter how you hurt, you will be left suffering - for your own good. Oddly, your Dr. will still send you for various treatments that might kill or injure you, but many now don't want to take the remote chance on you liking your suffering relieved. Why bother? Heroin anyone?
32
Perfect application for medical marijuana.
9
Which in MA has not been set up although it's been 5 years since the citizens of MA voted for it. Now they've voted for recreational cannabis and all of the townships are closing it down already. Good luck MA with their aging population and high opiate addiction rates. Cannabis cuts into the doctor's, their union and other medical businesses bank accounts. They lobby against it daily on Beacon Hill for this reason alone-greed.
1
I fell on the stairs and hit my tailbone thirty four years ago. I went to a chiropractor for a while. I have spent days unable to move after irritating it again. I did yoga and I walked. I still take Advil. For the past ten years I have been treated by an osteopath with OMT. The OMT really changed the story. My back is healthier than it has been in all this time and I am 70 years old. I agree that stretching and walking are very important to my back's health as well but the right kind of treatment is essential. So I would say that the doctor is right but also wrong. Osteopathy is a course of treatment that actually works. Stay away from the surgeons.
6
Back pain has plagued me for almost 20 years. I both agree and disagree with these new guidelines.
At my worst I was so disabled that I could not laugh or cough without bracing myself for support. I pulled myself up to standing using my bedside table. I tried massage, acupuncture, yoga. Nothing helped. My back was weak and in a cycle of chronic inflammation. I was demoralized and crippled. My Dr. prescribed 3 months of physical therapy. No relief, but the muscles were now stronger. Then...CORTISONE injection! Within 24 hours the pain was gone. I woke from sleep that night because my constant back pain was gone! My Dr. said PT had strengthened my core & cortisone interrupted chronic inflammation that had become a 'neurological habit'.
After 1 more cortisone shot I have lived 12 years with minimal back pain that spikes after certain stress activities but control it with ibuprofen. BUT I did not have a regular exercise regimen until after the elections when I began taking boxing classes to vent my frustration and focus my mind (yoga was impossible).
Boxing is a work out! Lots of abs work. My muscles ached for 2 weeks but my core was getting stronger. 3 months later my mid section looks better than it has in years and I have virtually eliminated any trace of back pain. My back feels younger than it has in years!
So if you have no major structural problem cortisone (with PT first) is miraculous for chronic lower back pain. Then hard core exercise is the path to a new back.
At my worst I was so disabled that I could not laugh or cough without bracing myself for support. I pulled myself up to standing using my bedside table. I tried massage, acupuncture, yoga. Nothing helped. My back was weak and in a cycle of chronic inflammation. I was demoralized and crippled. My Dr. prescribed 3 months of physical therapy. No relief, but the muscles were now stronger. Then...CORTISONE injection! Within 24 hours the pain was gone. I woke from sleep that night because my constant back pain was gone! My Dr. said PT had strengthened my core & cortisone interrupted chronic inflammation that had become a 'neurological habit'.
After 1 more cortisone shot I have lived 12 years with minimal back pain that spikes after certain stress activities but control it with ibuprofen. BUT I did not have a regular exercise regimen until after the elections when I began taking boxing classes to vent my frustration and focus my mind (yoga was impossible).
Boxing is a work out! Lots of abs work. My muscles ached for 2 weeks but my core was getting stronger. 3 months later my mid section looks better than it has in years and I have virtually eliminated any trace of back pain. My back feels younger than it has in years!
So if you have no major structural problem cortisone (with PT first) is miraculous for chronic lower back pain. Then hard core exercise is the path to a new back.
5
As a pain medicine specialist, I can tell you that there is absolutely nothing new in these guidelines. We have known and recommended the same things for at least 25 years.
As long as doctors and hospitals are going to get paid a lot to do unnecessary tests, injections, and surgery, they will continue to do them although all research has demonstrated that for most patients these are not only unnecessary but have a chance of making the pain worse.
As long as doctors and hospitals are going to get paid a lot to do unnecessary tests, injections, and surgery, they will continue to do them although all research has demonstrated that for most patients these are not only unnecessary but have a chance of making the pain worse.
18
I agree with many of the other comments that this article doesn't begin to address the range of different types of back problems. Yes, many times when my back goes out, a few muscle relaxer pills help me to keep up my normal activities. But in the past, I have been in pain for two years with no treatment but advil, physical therapy and advice to sit in a chair with a straight back. A steroid injection finally resolved the pain. Or perhaps you think it was time or it was a placebo? I don't think so.
9
TLF: How would you know you didn't experience a placebo effect? It can be very effective.
And during those times did you do yoga or PT exercises regularly, like 5 hours a week? Just curious.
Robin McKenzie's book "Treat Your Own Back" was recommended by my husband's orthopedist when he hurt his back. It's been a life saver especially if you do the stretches/exercises BEFORE you are in excruciating pain. The "emergency" stretches are also very helpful during episodes of extreme pain. I've given the book to both my children. I believe there is place for pain medication although I avoid it because I get sick on my opioids. Learning to recognize the signs of increasing back pain (which usually indicate that I'm about to have a severe back episode) and taking time to stretch, do yoga, exercise on the treadmill, etc. have definitely improved my life.
3
I liked the book "Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain" by Dr. Ronald D. Siegel -- I have a many years old copy sitting on my shelf. It sounds very similar to the one you recommended, in that it suggests exercises to do to help alleviate back pain and then to avoid it in the first place by strengthening the back muscles.
The most important non-pharmacological and non-surgical measures are designed to restore normal posture and eliminate lordotic tilt of the pelvis. They are weight loss to approach an ideal body weight and strengthening of the core abdominal muscles. Muscle strengthening can be isometric; it need not require sit ups and similar exercises, only tensing of the abdominal muscles in either a sitting or standing position are required. Weight loss changes pelvic dynamics and tends to reverse pelvic tilt (lordosis).
15
basically I had a herniated ruptured disk that spewed out and entrapped the sciatic nerve. This was 15 years ago. I was in pain for one year at the tune of 13 Ibruproven a day for eight months then switched to Naproxsim. I had Massage, Rolfing, Acupuncture every week for a year, I was able to trade because I am in the business. At one point a friend gave me her Darvasette that she got from a dentist for a tooth ache. No one ever would give me any pain medication, not even the surgeon I saw who did the MRI. Taking so much Ibruprofen I was able to continue to work but by the end of the day I could only sit to cook dinner for my kids. For almost two months I was in excruciating pain. It took two years to recover. In the end I took Yoga and that got my strength back. It was an awful experience and I do think someone needed to give me pain medication in the beginning, not only did my back hurt but I thought I must have a broken leg because of the nerve pain and the nerve pain was the last to heal. I am fine now.
7
Stacey -- Pain meds did not touch my pain from a similar rupture T11-12. High-power steroids helped me get through it until I could walk a little and do yoga. I'm glad you're feeling better now.
My fix...medical marijuana, chiropractic and exercise. Medical marijuana helped me to kick opiods and chiropractic keeps my DISH (spinal disease) and associated pain in check. IMHO this is an incomplete and Physician biased method making this an incomplete and biased report.
15
You have to read the full report which no doubt contains a whole section dedicated to what Mike says in addition to the rest of the report based on actual medical evidence.
I'm looking forward to my state legalizing medical MJ.
Americans have been brainwashed by Big Pharma to believe that only a pill can solve their medical problems. I am a very active middle aged adult who has had some back issues mainly due to an active lifestyle and aging. I am very fit, run, bike, swim, ski. It got to the point where I could not do the things I love. Found a great DO who works on people like me. Now every three months she works on me - no insurance, but totally worth it. I don't take anything stronger than an aspirin. But I keep my weight in check, I exercise every and I watch what I do - no heavy lifting. Americans generally are too lazy to exercise and don't want to do the hard stuff. No pills or surgery in this household.
11
In the same way we've been brainwashed by Big Pharma and the psych-industry for whom every little bump in life calls for prescriptions for brain altering drugs, often taken for years on end with little assurance of working and numerous side effects.
1
Swimming, or water exercise offers tremendous value. Try it.
9
You are absolutely correct. Unfortunately for many, perhaps most, swimming is not a viable option. Either no pool is available and/or no pool is affordable.
1
YMCA
Not everyone has a conveniently located YMCA and even when there is one not everyone can afford their fees.
I've had bulging discs for 35 years, and a herniated disc for 16. After laying in bed for 2-3 days after the herniated disc, I started walking. After some days, my pain subsided. By the time I got an MRI and saw an orthopedic surgeon, my pain was gone! The surgeon said he would have recommended a fusion and was amazed I was pain free. Now if I walk 0.5-4 miles per day, I have no problems. Unfortunately, I've never run I'm these 35 years in fear of making things worse.
9
It is refreshing to hear that someone else tried this method and it worked. At 39 I took a very bad fall and ruptured a disc severely. Yes, it hurt like something awful, but narcotics and steroid injections did not do a thing. When asked about an MRI, I said no, would it make any difference. My very sage orthopedist said that most folks are equally as good with surgery or therapy at the end of six months. Sure enough, I went on a regime of ibuprofen, which helped immensely, and walked pain or no pain. Went to therapy to learn some exercises to do at home. Low and behold, 21 years later no surgery and only intermittent mild problems with my back. It was hard, but honestly, took less time than if I had surgery which often leads to multiple more.
Having just lived through some back pain I can say that the hardest thing is trying to remain flexible. It's so much easier not to move in ways that provoke pain. What helps me whenever I do hurt myself this way, whether it's my back or some other part of my body, is exercise, swimming to be specific. I'm weightless in the water. The pool water is usually warm and I can, at the end of my swim, stretch a bit. A hot shower after my swim goes a long way too.
There is not way around getting older, a bit stiffer, and having the occasional back problem. However, inactivity does not cure it. If you have to ease into the day carefully, do it. Adjust your chair at work to support your back. Take the OTC painkiller but be careful how you move. Most important of all, pay attention to what helps and keep doing it. Don't accept getting older as an excuse to be unable to reach your toes while keeping your legs straight. If you've been able to do it for 45 years or more keep on trying even if your back hurts. Just be careful.
There is not way around getting older, a bit stiffer, and having the occasional back problem. However, inactivity does not cure it. If you have to ease into the day carefully, do it. Adjust your chair at work to support your back. Take the OTC painkiller but be careful how you move. Most important of all, pay attention to what helps and keep doing it. Don't accept getting older as an excuse to be unable to reach your toes while keeping your legs straight. If you've been able to do it for 45 years or more keep on trying even if your back hurts. Just be careful.
5
"Go run" With lower back pain? I hope Dr. Weinstein was joking.
I have spondylolisthesis (a condition in which one vertebra "slides" forward over the vertebra below it), which causes chronic lower back pain. On bad days, I can barely walk, much less run.
Several doctors have recommended surgery. However, the success rate for spondylolisthesis surgeries is less than 70 percent, not at all encouraging.
I have been prescribed many pills, but I restrict myself to ibuprofen only when the pain bothers me too much. Mostly, I have resigned myself to have some degree of pain, and make a point of not letting the pain rule my life.
The most effective measure, which is not at all mentioned in this article, is exercise. Just not any exercise, but exercise adequate to my problem, and avoiding twisting or bending, weight lifting, and high impact activities (like running).
However, it takes a very experienced physiotherapist to prescribe and follow up and adequate treatment regime. Supplementary treatments include hot/ cold therapy, ultrasound and electric stimulation (TENS). In the US, I have not been able to find a physiotherapist with the ability to successfully treat my problem. The best treatment I have received, which made my pain almost disappear, was in Bogota, Colombia.
Also, many insurance plans will not cover long term physiotherapy; they would rather pay for the surgery.
In short, back pain is much more complicated than doctors' recommendations in this article.
I have spondylolisthesis (a condition in which one vertebra "slides" forward over the vertebra below it), which causes chronic lower back pain. On bad days, I can barely walk, much less run.
Several doctors have recommended surgery. However, the success rate for spondylolisthesis surgeries is less than 70 percent, not at all encouraging.
I have been prescribed many pills, but I restrict myself to ibuprofen only when the pain bothers me too much. Mostly, I have resigned myself to have some degree of pain, and make a point of not letting the pain rule my life.
The most effective measure, which is not at all mentioned in this article, is exercise. Just not any exercise, but exercise adequate to my problem, and avoiding twisting or bending, weight lifting, and high impact activities (like running).
However, it takes a very experienced physiotherapist to prescribe and follow up and adequate treatment regime. Supplementary treatments include hot/ cold therapy, ultrasound and electric stimulation (TENS). In the US, I have not been able to find a physiotherapist with the ability to successfully treat my problem. The best treatment I have received, which made my pain almost disappear, was in Bogota, Colombia.
Also, many insurance plans will not cover long term physiotherapy; they would rather pay for the surgery.
In short, back pain is much more complicated than doctors' recommendations in this article.
76
See a physiatrist. After months of specialists and tests at one of the most prestigious hospitals in the country regarding a severe injury in my hip area, I was directed by a coworker to a physiatrist. I was in the examining room with him for 15 minutes and never had pain or discomfort after that appointment. It has been seven years.
6
The cause of back pain can indeed be complicated and I wrestled uncomfortably with mine for two years in my forties before it resolved with time and stretching. Since then I've had it once or twice a year. I'm now 76 and having some muscle spasms again, probably from overuse at Gold's Gym - and not addressing the pain soon enough. Knowing it's likely to lessen or go away over a period of weeks or months makes it more tolerable altho sitting is a pain. There is no magic pill but ibuprofen and muscle relaxants and warm showers help. I would not even think about going out and RUNNING right now - or ever, because running did me in in my forties. I will consider massage, physical therapy and lighter exercise like walking until it resolves. I also use a gel pad for extended sitting which is an oxymoron because I shouldn't sit longer than 20 minutes without getting up to walk around.
I think this article is talking about common lower back pain. Not actual medical conditions that need medical attention. There is a difference. I have chronic back pain and i have learned how to deal with it without medicine. And for me the doctors are right. I've had the xray telling me I have bulging discs. And they can't do anything did that. I have to do it. Tre as the it at home or go to therapy. Medicine doesn't fix my back.
1
Big Pharma has such a stranglehold on insurance companies that alternative therapies like acupuncutre are not paid for. I have a wonderful, highly trained alternative healer who uses medical massage, acupuncture, osteopathic manipulation (which is different from chiropractic and requires extensive training), warmth, music, herbal medicine, nutritional advice and aromatherapy. She makes me feel terrific. At $85 for a 90-minute treatment, it's a huge bargain. But my insurance pays not a penny. This is the insurance plan that every State of Texas employee is provided. This is a racket if I ever saw one.
10
If the insurance companies get in on this, you can expect two things:
1) Your premium will go up
2) That $85 treatment will now cost $400 of which you'll still pay the copay
An old man once said: Nothing is free.
1) Your premium will go up
2) That $85 treatment will now cost $400 of which you'll still pay the copay
An old man once said: Nothing is free.
1
Although it will most certainly be dismissed as anecdotal, I and everyone I know who lives and works on a farm can tell you without doing an expensive study that daily exercise and a simple NSAID goes a long way towards keeping pain-free mobility. On a farm there is no choice but to get up every single day and care for the animals; we deal with the same aches and pains as everyone else but I don't know of a single farmer who has been debilitated to the point of inactivity and/or pushed to use strong painkillers.
On the other hand, I've seen young (late 20s/early 30s) relatives undergoing shoulder surgeries, back surgeries and all manner of expensive therapies on muscles and joints, due to their sedentary lifestyles or their 'weekend warrior' exercise regimens. My spouse and I are 60 and 65 and still going strong with the occasional Aleve. We've been through bouts of back pain, shoulder pain, frozen shoulders and assorted other ailments but always bounce back even as we continue our daily routines.
The prescription is:
Keep moving, take an NSAID, have patience.
On the other hand, I've seen young (late 20s/early 30s) relatives undergoing shoulder surgeries, back surgeries and all manner of expensive therapies on muscles and joints, due to their sedentary lifestyles or their 'weekend warrior' exercise regimens. My spouse and I are 60 and 65 and still going strong with the occasional Aleve. We've been through bouts of back pain, shoulder pain, frozen shoulders and assorted other ailments but always bounce back even as we continue our daily routines.
The prescription is:
Keep moving, take an NSAID, have patience.
49
I'll second that! I've had back pain off and on for decades; it's acted up in the last couple of years after too many weeks of building rock walls. I've tried a two-week course of OTC Aleve, on doctor's OK, which helped, and have started a tailored 10-minute-a-day exercise program, which has helped a lot. But I notice that the pain appears only after especially heavy work days, and on days when I do NOT do farmwork. It genuinely helps to keep moving.
1
This article is appalling. Yes, many of the millions of people who sustain injuries to their backs every year are just "sore," and will get better. But plenty of us who rupture a disc end up needing the MRI, a steroid injection, and, yes, even narcotics, should not be dismissed or told not to "medicalize" our very serious condition.
These suggestions to do yoga or get acupuncture more than ignore their lack of availability or affordability. The $10 prednisone or Vicodin prescription is what our insurance system is set up to accommodate. Let's see these doctors advocate for alternative therapies becoming part of medical care before they dismiss back pain sufferers and tell them to get over it, move on, and quit expecting s doctor to help them with pain, For sure those modalities help any medical ailment, but are nowhere to be found in the system as it currently exists for most Americans.
These suggestions to do yoga or get acupuncture more than ignore their lack of availability or affordability. The $10 prednisone or Vicodin prescription is what our insurance system is set up to accommodate. Let's see these doctors advocate for alternative therapies becoming part of medical care before they dismiss back pain sufferers and tell them to get over it, move on, and quit expecting s doctor to help them with pain, For sure those modalities help any medical ailment, but are nowhere to be found in the system as it currently exists for most Americans.
224
First of all, true herniated discs or what you may call "ruptured" occur in a very small number, i.e, less than 2%, of people with back pain.
Second, there is no evidence steroid injections or opioids provide much benefit for those who suffer them nor does surgery.
And if you disagree with this, please cite studies contradicting what I've said.
Second, there is no evidence steroid injections or opioids provide much benefit for those who suffer them nor does surgery.
And if you disagree with this, please cite studies contradicting what I've said.
3
Ella:
Contrary to being appalling, Ms. Kolata (who is just reporting current changes in ACP guidelines coupled with a bit of expanded detail) is precisely on target with her reporting. We oversell medicine of all sorts--conventional and alternative--in this country. This is one of the three main reasons for our outlandish national medical costs (the other two are administrative overhead and the expense of individual services).
There is reason to just push ahead with much of acute pain that is not too disabling. These columns are no place for nuanced recommendations for individuals, but so much of acute pain is over-treated--not to mention chronic pains. That will not stop individuals from testifying about their favorite or most maligned options.
If you are going to tell me that alternative medicine, including nutraceuticals, are not oversold, then it is very difficult to have a meaningful conversation. (That is hard enough on a discussion board.)
Contrary to being appalling, Ms. Kolata (who is just reporting current changes in ACP guidelines coupled with a bit of expanded detail) is precisely on target with her reporting. We oversell medicine of all sorts--conventional and alternative--in this country. This is one of the three main reasons for our outlandish national medical costs (the other two are administrative overhead and the expense of individual services).
There is reason to just push ahead with much of acute pain that is not too disabling. These columns are no place for nuanced recommendations for individuals, but so much of acute pain is over-treated--not to mention chronic pains. That will not stop individuals from testifying about their favorite or most maligned options.
If you are going to tell me that alternative medicine, including nutraceuticals, are not oversold, then it is very difficult to have a meaningful conversation. (That is hard enough on a discussion board.)
you've missed the point. First, the guidelines specifically exclude back pain accompanied by sciatica or other nerve-impingement pain that would result from a deteriorated disc or similar trauma/condition so that patients with this type of specific, identifiable condition can receive the treatment they need.
Second, the article is clear that the conditions addressed are more generalized "low-back ache" where there is not an identifiable precedent. These conditions, which represent the VAST majority of back-pain complaints, are not helped by surgical intervention or pharmaceuticals, and are often made WORSE by such interventions either due to the return of symptoms (surgery) or opioid addiction.
The article states that doctors believe that while surgery and pain relievers carry significant risks and no promise of relief, continuing to move and breathe has the potential to allow a person to return to their normal lives and manage their pain. There is nothing appalling about that.
I can appreciate that you are currently in pain and that's a terrible burden to carry day in and day out. This article may offer you some insights and inspiration. It features an MD in Mass. who went through each of these experiences and the program he developed as a result.
https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidel...®ion=Header&action=click&contentCollection=Trending&pgtype=article
Good luck!
Second, the article is clear that the conditions addressed are more generalized "low-back ache" where there is not an identifiable precedent. These conditions, which represent the VAST majority of back-pain complaints, are not helped by surgical intervention or pharmaceuticals, and are often made WORSE by such interventions either due to the return of symptoms (surgery) or opioid addiction.
The article states that doctors believe that while surgery and pain relievers carry significant risks and no promise of relief, continuing to move and breathe has the potential to allow a person to return to their normal lives and manage their pain. There is nothing appalling about that.
I can appreciate that you are currently in pain and that's a terrible burden to carry day in and day out. This article may offer you some insights and inspiration. It features an MD in Mass. who went through each of these experiences and the program he developed as a result.
https://www.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidel...®ion=Header&action=click&contentCollection=Trending&pgtype=article
Good luck!
2
It is concerning that there is a witch hunt after opioids. Opioids do work. If anything they have a calming effect that prevents people from damaging the recovery process by try to get going before they are healed. It reminds me of the witch hunt for cannabis that has been waged for seventy plus years. Sensible policy not scare tactics flamed by news media is the answer. Ibuprofen is just as dangerous as opioids maybe more so. The one thing this article has correctly identified is that most back pain does not require a lot of costly intervention, lose weight get active tighten your core muscles. Join a yoga class or stretch in the morning. The only thing that is required is time out of your busy schedule. Avoid the orthopedic witch doctor.
17
Sorry, but opioids have decimated our society. Yes, they are a crucial part of medicine, especially palliative and end-of-life care, and I wouldn't want that to change. But if there's a "witch hunt" it's because the abuse of these drugs, and of heroin when people can't get the prescription stuff anymore, is at epidemic proportions and we have to keep shouting about it, and part of that involves rethinking some uses of these medications. I have a relative who works in nursing-home care and in the past three years the average age of residents in her facility has dropped by probably 10 years -- because the facility now is also home to an entire ward of young people with permanent brain damage sustained via heroin overdoses. Saying ibuprofen (which, yes, has to be consumed with caution for effects on the liver) is maybe more dangerous than opioids is nonsense, as is the comparison to cannabis -- when was the last time a dozen people got carted to the same ER in the course of a night half-dead from smoking too much weed?
2
Glad to hear this. Although most aspects of modern medicine are wonderful, our bodies have the ability to effectively and efficiently deal with a plethora of ailments without the intervention of drugs or surgery. PT and/or exercise > drugs any day.
3
Insurance companies are more ready to have doctors prescribe drugs than to cover the Physical Therapy necessary to heal and to prevent the problem from occurring again. This was pointed out in a NYTimes article a few years ago.
Insurance doesn't cover regular chiropractic care and massage that keep me HEALTHY.
Insurance doesn't cover regular chiropractic care and massage that keep me HEALTHY.
7
Well, that's all fine and good when the costs for PT and Yoga classes are covered by insurance. Accupuncture and other alternatives would help too if they were covered. But our medical insurance and providers are plugged into Big Pharma, so.........
9
Unfortunate, isn't it? Prevention does not make tons of money, dealing with a patient once very sick, does.
1
You can get a book with PT exercises and a yoga tape from the library if you are poor. Sure, you need motivation, but don't we all?
As a person with a history of severe stenosis (I am only 49 years old and have had two surgeries) I am all for alternative treatments and therapies. If my ObamaCare insurance would cover acupuncture and physical therapy that would seriously help. Sometimes it is easier and cheaper to pop three Advil then haggle with the insurance company over how many PT sessions they will allow me. I can get my hands on all sorts of medications, MRIS, surgeries from the insurance company but I can't get approval for acupuncture. Doesn't make sense.
9
No, it does not make sense. Our medical system is not geared toward prevention but dealing with a patient once she/he is very ill. This is were the huge profits come in.
Just imagine what we will be faced in the future when half of the population is sich with Diabetes2.
Just imagine what we will be faced in the future when half of the population is sich with Diabetes2.
2
As a Physical Therapist, who has been in the clinic a long time, early intervention and movement is the key to recovering from back pain. This article mentions a lot of treatments that are passive in nature. Patients do need education based upon timeline of healing and appropriate exercises. A graduated return to activity is best. Telling someone to go for a run with back pain, is setting them up for failure.
14
Or you can read John Sarno's Healing Back Pain.
I keep a copy handy in case I feel even a hint of pain and read a few pages to remind myself of the source of the pain. The book costs less than $10 and no doctor visit required.
I keep a copy handy in case I feel even a hint of pain and read a few pages to remind myself of the source of the pain. The book costs less than $10 and no doctor visit required.
13
Sarno's book is excellent! It helped me immensely and kept me going through months of chronic back pain. I've read it twice and highly recommend it.
2
Dr Sarno's book has made a huge difference in my life and saved me from chronic back problems. I can't say enough about it.
2
Healing takes time and often extensive physical therapy. Time is something most Americans don't have, and therapy costs money -- something else many Americans don't have. The Republicans are cutting our health insurance and the medical community is recommending a severe reduction in opioid prescriptions.
Tell that to the young, uninsured mother with small children, who works two part-time jobs and must frequently lift her toddler. Tell that to the self-employed underinsured building contractor who can't stop work for physical rehab or time off to heal. Tell that to the injured veteran whose truck was blown up in Kabul by an IED and now must use two canes just to walk his service dog.
When misused, opioids can cause addiction. But they also save lives that would otherwise be destroyed by crippling chronic pain.
To dismiss these pain victims as pill-seeking junkies looking for a high is cruel. Taking away their opiates will create a large class of desperate black-market buyers and cause bigger problems for our country than pain pills ever have. The only beneficiaries will be the drug dealers and the private prison industry.
Tell that to the young, uninsured mother with small children, who works two part-time jobs and must frequently lift her toddler. Tell that to the self-employed underinsured building contractor who can't stop work for physical rehab or time off to heal. Tell that to the injured veteran whose truck was blown up in Kabul by an IED and now must use two canes just to walk his service dog.
When misused, opioids can cause addiction. But they also save lives that would otherwise be destroyed by crippling chronic pain.
To dismiss these pain victims as pill-seeking junkies looking for a high is cruel. Taking away their opiates will create a large class of desperate black-market buyers and cause bigger problems for our country than pain pills ever have. The only beneficiaries will be the drug dealers and the private prison industry.
201
Well said.
Please explain to me how spending hundreds of billions of dollars each year on needless tests and procedures fits with your concept of how we are denying people proper treatment because of financial concerns.
1
"The only beneficiaries will be the drug dealers and the private prison industry."
You forgot the funeral industry.
You forgot the funeral industry.
If I read this correctly, the advice to Doctor's is that they should take no action or pain management prior to 12 weeks. I think it is pretty smug of the American College of Physicians not to even acknowledge that most people would loose their jobs if they were not at work for at least 3 months and the effect of long term chronic pain can have lasting impact on patients ranging from depression to post traumatic stress disorder.
Have had two back surgeries and having reviewed the current studies it is amazing that there has been remarkably little research. The last real longitudinal study was the Dartmouth SPORT study which was completed in 2008 and the NIH library has just a few small statistically invalid studies on more effective surgical techniques that could increase the efficacy of surgery. It is the lack of research on therapeutic strategies that is shocking and if the amount of research that has been focused on dermatological disorders was applied surgical and non surgical therapies that could both address spine disorders and preventive and predictive techniques that would make a difference in the growth of chronic spinal injuries.
Have had two back surgeries and having reviewed the current studies it is amazing that there has been remarkably little research. The last real longitudinal study was the Dartmouth SPORT study which was completed in 2008 and the NIH library has just a few small statistically invalid studies on more effective surgical techniques that could increase the efficacy of surgery. It is the lack of research on therapeutic strategies that is shocking and if the amount of research that has been focused on dermatological disorders was applied surgical and non surgical therapies that could both address spine disorders and preventive and predictive techniques that would make a difference in the growth of chronic spinal injuries.
11
Excellent report.
The moral/game plan......
1-Start with proven non evasive, non drugs programs like exercise, walking, yoga etc.
2-Use non prescription pain killers as needed ie if the pain is really bothersome and one has to perform at work or home.
3-Don't operate unless the operation has a proven track record of really helping you.
4-If you are overweight, lose weight.
If you can't, don want to, a rare case, then by all means take heavy prescription pain killers. The will work for a while but in the end will make the situation much worse..
The moral/game plan......
1-Start with proven non evasive, non drugs programs like exercise, walking, yoga etc.
2-Use non prescription pain killers as needed ie if the pain is really bothersome and one has to perform at work or home.
3-Don't operate unless the operation has a proven track record of really helping you.
4-If you are overweight, lose weight.
If you can't, don want to, a rare case, then by all means take heavy prescription pain killers. The will work for a while but in the end will make the situation much worse..
5
Take opioids and in the end it will make things worse? Really, based on what exactly, your thoughts. Everyone's situation is different, and blanket statements on what works for everyone are ignorant
1
I've used opiates since 1999 after blowing a disc at L3 on the right side and a crushed nerve from stenosis at L3 on the left side.
Without them I couldn't have continued to run my business and worked as a technician pulling voice and data cabling until 2015.
I submit to surprise urinalysis and pill counts to ensure that I am not selling my pills or supplementing them.
The situation worsens but not because of the medications. It's further degradation of the physical condition.
Without them I couldn't have continued to run my business and worked as a technician pulling voice and data cabling until 2015.
I submit to surprise urinalysis and pill counts to ensure that I am not selling my pills or supplementing them.
The situation worsens but not because of the medications. It's further degradation of the physical condition.
1
Thank you for your reply Tom...read the last paragraph of my post...if you can't, dont want to or are the rare case then take them but in the end most people would be better off not taking them. I have several people in my family with bad backs and many are overweight, do not want to exercise etc., end up going on opioids and they tell me in the end it is a mistake and that exercise and losing weight eventually helped them the most.
2
As a yoga therapist, I can attest to the healing power of yoga, in many forms (gentle, chair, therapeutic, etc) as a palliative for chronic pain. Understanding and accepting that pain is part of the human condition helps us have compassion for all other beings that suffer. Running away from pain only prolongs it. Yoga with its 8 limbs is as good as it gets in this world, and teaches us how to age mindfully.
5
It's great that the trend is currently away from medication for whatever reason. I often suggest that my massage therapy clients observe their pet animals, who always stretch when they wake up and during their activities. Relearning this natural process can be greatly facilitated by the "alternatives" mentioned in the article; physical and massage therapy, chiropractic, acupuncture, yoga, exercise. It remains to be seen how healthcare politics and insurance will shake out on this.
61
RG, your comments remind me of when I worked in an assisted living facility just out of college about 44 years ago. One elderly resident told me about the stretches she did in bed before she got up; she said it helped get her blood flowing and her muscles unstiffened. I started using her methods, and haven't stopped. I've even taught my husband of 8 years to do them. So far, so good. And I'm reminded of these stretches every time I see our little lame dog stretch in his bed, and stretch after getting up -- and he's been lame from the day we rescued him 12 years ago.
1
This is the "grin and bear it" approach to treating chronic low back pain.
5
I had shoulder surgery. Torn rotator cuff. Worst pain I ever experienced. I was prescribed an opioid. Not only did it not work it got me constipated. I switched to Alleve, (naproxin sodium). It worked and no constipation.
Just because a medication is over-the-counter doesn't mean that it is any less effective than the prescription drugs that the doctors are persuaded to prescribe by the drug companies.
Just because a medication is over-the-counter doesn't mean that it is any less effective than the prescription drugs that the doctors are persuaded to prescribe by the drug companies.
3
Articles like these should include the latest information about medical marijuana. The anecdotal evidence about the many beneficial effects of pot is enough that it should be removed from Schedule 1 and be thoroughly researched. The high paying jobs for this R&D should be enough reason.
7
Why not eliminate opiods and painkillers for all conditions if people are going to become addicted? I have lived in pain for twenty years with degenerative disc disease --another "common cold" ailment. Whenever you hear a doctor make the common cold analogy you know he is really saying "let them suffer."
15
"Go for a run." Wow. Just...wow. Spoken truly as a person who has never writhed on the ground with back spasms.
While I understand, from another article, that many back surgeries are unnecessary and counterproductive, telling a person in pain to "go for a run" reveals the true heartlesssness of a doctor who cannot conceive of the depths of pain suffered by a person with back pain. Over the counter anti-inflammatories, the application of heat and cold - not mentioned in your article-gentle stretching, massage - all of these things can help return a sufferer to health.
But first let me get the guy with the spasming back up off the floor...
Amy Lesemann
While I understand, from another article, that many back surgeries are unnecessary and counterproductive, telling a person in pain to "go for a run" reveals the true heartlesssness of a doctor who cannot conceive of the depths of pain suffered by a person with back pain. Over the counter anti-inflammatories, the application of heat and cold - not mentioned in your article-gentle stretching, massage - all of these things can help return a sufferer to health.
But first let me get the guy with the spasming back up off the floor...
Amy Lesemann
47
Well said. I concur absolutely. Empathy is missing from most treatment plans.
1
Amen! I am a stoic person, but have never experienced pain as intense as when my lower back muscles go into spasm. On more than one occasion, it has made me fall to the floor, crying, unable to get up for many minutes. Afterwards, I can't even stand up straight for days on end. The idea of trying to "tough it out" through such an episode, without at least some NSAIDS or a muscle relaxant, is mind-boggling.
1
Okay. So why isn't massage therapy covered by Medicare??
9
I am going to post this in my office and make it into a handout for patients who want their opioids
1
I urge the medical community not to swing too far towards the anti-pain killer side of this equation. Extreme pain can send one to the brink of suicide. At age 29, I suffered excruciating lower back pain with radiating leg pain that immobilized me and utterly prevented me from caring for my husband and four young children or working as a teacher. During that ordeal, I thought of suicide as a vable option out of the physical hell I was in. That was the mid-1970s when opioids were not prescribed routinely and MRIs didn't exist. After many months, I was diagnosed with a spinal stenosis and cured with surgery. Blessed relief! My heart hurts for anyone who is forced to suffer the same fate now simply because her doctor is mindlessly following this new protocol.
51
This is more about bending the cost curve than bending and touching your toes. Don't worry. In twelve weeks you may be slightly better just by getting off your seat and moving around. Just like psa tests do more harm than good and breast x-rays aren't really needed very often. Let's make America suffer again so the insurance companies can prosper.
8
I'm able to have radiation therapy for my prostate cancer thanks to the PSA tests. You can't convince me otherwise. If I'd waited any longer my wife would be burying me just like I buried a pastor friend three years ago.
"I know your back hurts, but go run, be active, instead of taking a pill.”That has got to be the most stupid insensitive statement ever written about back pain. Doesn't anyone find it extremely convenient that these new recommendations are so in lock step with the new initiative in this country to tackle the opiate abuse problem here? What we have here is the use of the scientific establishment and it's aura of infallibility to push an antidrug agenda through. So it is now 'fact ' that Marijuana is okay and legal but the evil Opiates must go. I'm not buying it!
15
I heard a news article yesterday about how secondary smoke isn't a cause of cancer. How convenient now that marijuana is being legalized.
Not a word though how keeping that marijuana smoke in your lungs as long as possible isn't bad for you but a quick inhale and exhale of tobacco is.
There's a researcher for every cause. You can find one to support your idea for a large enough "grant".
Not a word though how keeping that marijuana smoke in your lungs as long as possible isn't bad for you but a quick inhale and exhale of tobacco is.
There's a researcher for every cause. You can find one to support your idea for a large enough "grant".
I believe that alternative medicine has a lot of value in treating non-nerve related back pain. However, most of these treatments are not covered by insurance. The very population who could theoretically benefit are cut out by the high cost of acupuncture, for example.
Efforts to control opioid addiction in this country should not prevent back pain patients from access to the help and treatment they need. It seems like throwing the baby out with the bathwater, to say the least.
Efforts to control opioid addiction in this country should not prevent back pain patients from access to the help and treatment they need. It seems like throwing the baby out with the bathwater, to say the least.
116
But the question is, are opiates the answer? My experience is that opiates tend to CAUSE pain. Sure, it'll feel good the first few times/days/weeks you take it, but inevitably you get tolerant to it. Then if you try to come off it, you get horrible withdrawal that many mistaken for a flare-up of their pain, so they take more of it.
And I've suffered from severe pain. I was hit by a car a year ago. Had three broken vertebrae in my back. And you know what I did? I went back to work in a week. I started walking and staying active. I went swimming EVERY MORNING and still do. I ignored the emergency doctor who wanted to drug me up. I never took any opiates. I only took tylenol and advil. And in three months, I was painfree. I shudder to think if I had started taking opiates what would've happened. There's no such thing as a free lunch. You can either suffer for a few weeks/months, or take the opiates, be pain-free or close to pain free for a few weeks but risk getting hooked on to this stuff and find it difficult to wean off and develop opiate induced pain for the rest of your life. I chose the former. Worked well for me.
And I've suffered from severe pain. I was hit by a car a year ago. Had three broken vertebrae in my back. And you know what I did? I went back to work in a week. I started walking and staying active. I went swimming EVERY MORNING and still do. I ignored the emergency doctor who wanted to drug me up. I never took any opiates. I only took tylenol and advil. And in three months, I was painfree. I shudder to think if I had started taking opiates what would've happened. There's no such thing as a free lunch. You can either suffer for a few weeks/months, or take the opiates, be pain-free or close to pain free for a few weeks but risk getting hooked on to this stuff and find it difficult to wean off and develop opiate induced pain for the rest of your life. I chose the former. Worked well for me.
This is very true! I've had low back pain for decades, and finally had surgery in 2009. I NEEDED Oxycontin, for about a month, after that surgery. I have Never had so much pain in my life! But, afterwards, walking, PT exercises, and Advil are the only things that keep me going. Walk, walk, walk!
4
Physiotherapists in western Canada often use a technique called intramuscular stimulation (IMS) on trigger point pain, a method that to my knowledge is used nowhere else. It's a miracle cure: pain goes away after only a handful of treatments. http://www.whythingshurt.com/what-is-ims-acupuncture-intramuscular-stimu...
I've never found chiropractic care to be useful, but obviously it works for some people.
I've never found chiropractic care to be useful, but obviously it works for some people.
2
Why has no one mentioned castor oil? This is a known home/folk remedy for back pain. You rub some of it into your lower back and then apply a heating pad for 1/2 hour.
I suffered through an awful back pain from a slipped disk for about six months when a friend mentioned this treatment. It worked. It's cheap ($5.00/bottle). It certainly isn't addictive and has no side effects (ok, it's messy.) What have you got to loose?
I suffered through an awful back pain from a slipped disk for about six months when a friend mentioned this treatment. It worked. It's cheap ($5.00/bottle). It certainly isn't addictive and has no side effects (ok, it's messy.) What have you got to loose?
2
We have a prescription drug opioid addiction epidemic on our hands, in large part, because of barely regulated pharmaceutical to physician marketing/sales/payment scheme that went on for decades. Healthcare providers were paid pushers, and the pharmaceutical companies made billions by training them to believe a pill was their solution. As a result, they find the magic "treatment" was their ticket to 30 - 90 days at an addiction treatment center.
The key is to figure out what treatments work, and force insurers to cover those treatments. Massage? Chiropractic? Whatever healthcare providers can prove works and the FDA approves should be covered by insurance.
The key is to figure out what treatments work, and force insurers to cover those treatments. Massage? Chiropractic? Whatever healthcare providers can prove works and the FDA approves should be covered by insurance.
2
I have back pain on occasions triggered by bending in certain positions. First time it happened I wasted time and money with physiotherapists and chiropractors. They were useless.
Then I discovered the benefits of walking and yoga stretches. I have to do it soon after the occurrence and absolutely resist the temptation to sit or lie down. Fixes it every time. Costs nothing.
Then I discovered the benefits of walking and yoga stretches. I have to do it soon after the occurrence and absolutely resist the temptation to sit or lie down. Fixes it every time. Costs nothing.
2
As someone who has had a variety of spine problems dating back to the late 1960s, I would suggest that the article falls short in not pointing out that these guidelines are not appropriate if sciatic nerve pain accompanies lower back pain. In fact, some of the types of exercise recommended in this report could be downright dangerous if there is disc impingement on the sciatic nerve. I know from bitter experience.
As soon as strong sciatic pain manifests itself along with lower back pain it deserves medical attention and imaging. Pronto! Not to have pointed this out is misleading in my estimation.
As soon as strong sciatic pain manifests itself along with lower back pain it deserves medical attention and imaging. Pronto! Not to have pointed this out is misleading in my estimation.
10
"I know your back hurts, but go run" Spoken by someone who has never experienced months of chronic pain.
I also wish insurance would pay for more alternative therapies, and I decry the dependence on opioids seen, but the gist of this article denies the life changing aspects of chronic pain, even for "a few months". How do you have a normal life when you can't stand on the subway to get to work? What is the quality of your home life when you can't sleep due to pain?
Medication isn't the only answer, but "just get on with your life" can't be it either.
I also wish insurance would pay for more alternative therapies, and I decry the dependence on opioids seen, but the gist of this article denies the life changing aspects of chronic pain, even for "a few months". How do you have a normal life when you can't stand on the subway to get to work? What is the quality of your home life when you can't sleep due to pain?
Medication isn't the only answer, but "just get on with your life" can't be it either.
297
NYCsandi--Boy, you're right about that! My insurance doesn't pay for much of the physical therapy, and certainly not for any fitness clubs that would help all of us stay healthy, so I do it at home. But, also, there are some less invasive surgeries, and pain treatments, these days, that are long lasting and not too expensive. I've had several epidural treatments, in my spine, top to bottom, and they don't hurt at all, and are very effective.
But perhaps you can explain to me the use of undergoing MRIs, injections, and surgery which research has consistently demonstrated provide little if any benefit to the overwhelming majority of patients who undergo them and often make things worse for the patient.
You seem to be saying it's better to do the wrong thing than to do nothing.
You seem to be saying it's better to do the wrong thing than to do nothing.
4
Steve--Would you mind showing us the research, please? Because, most of those treatments have worked for me. I may just have happened to find good doctors, instead of quacks.
1
I have been taking warm pool exercises at Chicago's Rehabilitation Institute (RIC) for nearly four years and I have not had a backache for more than three, except after extreme physical activity, e.g., with my first-grade grandson. I'd had backaches for more than 20 years and I believe the NSAIDS that I took for them led to my reduced kidney function. Movement is the cure and it's much easier in deep warm water. No more Ibuprofen or other NSAIDS for me!
1
Nope. Nope and nope. It's easy for people who don't have the problem to give such advice. As a person with "lower back pain," I beg to differ. MRIs help get a better diagnosis and give the doctor and patient a better idea of what's going on. When one has chronic pain that can't be managed through physical therapy, or alternative procedures, medications can make the difference between staying in bed while awaiting surgery, or being able to maintain some quality of life. It is true that opioids are addicting, but only if you take them when you don't need them. And the whole goal should be to stop using them when they are no longer needed. When you have collasping discs, going for a run is the worst thing you can do. Stenosis is a whole different ball game. I've just had my second laminectomy and fusion. Please don't suggest I go for a run. Just getting through my day (I teach) is enough to set things off if I'm not careful. And yes, I still take the occasional Valium or Norco to control muscle spasms and pain that can't be controlled any other way. I don't know who gave you your information, but I'm listening to my surgeon and my GP.
11
I think you touched on something important to remember: there are conditions where exercise and PT won't help. There are painful conditions where at this point you can either choose to destroy your liver and partially control pain with continued, intensive use of Ibuprofen, etc or you can get some good but temporary relief via opiods.. which loose effectiveness through time and are addictive and cause other problems. Sometimes it's Not. That. Simple.
8
I won't respond to all you say in the interest of space but with regard to your statement about MRIs it might interest you to know that repeated studies have shown that there is virtually no correlation between abnormalities noted on MRIs and the presence or severity of back pain. The problem is that surgeons rarely tell patients this and lead them to believe fixing these abnormalities is synonymous with relieving the pain.
In fact, 2/3 of the adult population without back pain have the same findings on MRIs as those with back pain do.
In fact, 2/3 of the adult population without back pain have the same findings on MRIs as those with back pain do.
4
At last, some common sense coming from the medical community about alternative, non-medication based treatments. On another note though, chronic back pain (for one) can sometimes be the physical manifestation of an underlying depression. Along with exercise and weight control, psychotherapy can often help.
4
As Lucy the Doctor says to Charlie Brown: "Snap out of it! Five cents, please!"
2
This is a hugely complex problem that requires thoughtful response; not a scatter-shot answer. I hope that practitioners who see patients with intractable and significant pain will keep opioids in their range of possible responses. In some cases pain is too great to allow useful physical therapy. Opioids are an available tool and should not be discounted out of hand because of another problem with their abuse. On top of that, it would be very helpful if the Substance Abuse Block Grants available to the states via the Substance Abuse and Mental Health Services Administration required a greater proportion of the grant money (now just 20%) be spent on evidence-based prevention practices rather than treatment. Between the ACA and the mental health parity laws, treatment is largely taken care of. A focus on prevention has a shot a saving lives.
8
Well, if you really think between the ACA and mental health parity laws, treatment is largely taken care of, you are mistaken. Yes, these have helped, for sure. But there is a big problem with lack of mental health practitioners for patients with Medicaid and have you ever looked at the (almost nonexistent) mental healrth benefits under traditional Medicare? Few psychiatrists take assignment under Medicare in any case. Is it no wonder that the greatest number of prescriptions for psychotropic drugs are written by primary care providers? What's more, despite the mental health parity laws, there are visit limits and restrictions on the type of therapy covered. There are limits on the number of PT visits and not all plans cover complementary medicine therapies, such as acupuncture. I agree prevention is important. But we still do not have the infrastructure or reimbursement system that would facilitate the recommendations made in the article.
1
Fantastic article and new guidelines.
2
Oh, you mean my use of advil two times daily for 2 to 3 days, together with the administration of cold packs, which alleviates the problem, is just a figment of my imagination?
4
After suffering back pain that made even getting out of a car tortuous, I tried gentle yoga three times a week for three months along with daily exercise, including miles-long walks. Back pain is gone. I continue to do gentle yoga with a chair to keep the back and spine limber. Wonderful how well the body responds to this form of wellness. Try it!
7
Yes, for chronic back pain most can and do get better with the suggested treatments. Acute injury? I spent a week in the most severe pain I've ever experienced (including two labors) before I was given strong pain meds and finally got relief. And like other readers, physical therapy was a lifesaver. It makes no sense we can't access them in California without a prescription but we can go to a chiropractor that could potentially do much more harm than good.
2
Finally!
The number of people who inadvertantly end up hooked on painkillers is astonishing, making their pain worse and worse until they end up on disability. Finally, some common sense guidelines!
The number of people who inadvertantly end up hooked on painkillers is astonishing, making their pain worse and worse until they end up on disability. Finally, some common sense guidelines!
4
"Finally?" We've had guidelines saying the same things going back at least 25 years. Doctors have ignored those and will ignore these because they can make tons of money by doing so.
3
Of course one's first reaction is to take a pill. One has a life with
kids to pick up from school , errands to run or a work assignment to be completed. Taking a pill is the most convenient option.
A doctors appt can take time to arrange . Physio or any testing will
be expensive and schedules will have to be rearranged.
So of course taking a pill , in the real world , is the only option.
kids to pick up from school , errands to run or a work assignment to be completed. Taking a pill is the most convenient option.
A doctors appt can take time to arrange . Physio or any testing will
be expensive and schedules will have to be rearranged.
So of course taking a pill , in the real world , is the only option.
3
Surprisingly this article has a lot of good points number one being don't START treating pain with our synthetic heroin aka oxycontin. I wish the Times wasn't so Establishment and ossified is they weren't they would have mentioned how pot has been the number one go to choice for pain often doing the job before our quack doctors either deny you treatment or give you a bunch of pills. That our current heroin epidemic is still being cause by an aging population in the physical work force and our parts are wearing out. Tragically most states take a combative view of it's citizens getting health care from them hence our broken system that is the number 3 cause of death just under cancer and the number one cause of bankruptcy.
The Times also mentioned that patients like me get severely punished if we got off the Oxy by ourselves. In my case I had my entire life destroyed by the state of Colorado. My "crime": conspiracy to see a doctor. Of course the Times or any other "legitimate" news source will NEVER look into that part of our rotten vile health care system.
The Times also mentioned that patients like me get severely punished if we got off the Oxy by ourselves. In my case I had my entire life destroyed by the state of Colorado. My "crime": conspiracy to see a doctor. Of course the Times or any other "legitimate" news source will NEVER look into that part of our rotten vile health care system.
4
Please present the research supporting your contention that pot is the number one go to choice for pain. I mean actual controlled studies and not anecdotal evidence.
And don't tell me that research has never been done on cannabis because of restrictions. The problem is that research has been done and that it has shown cannabis provides limited benefits for any conditions except nausea and vomiting related to cancer treatment and weight loss and poor appetite related to AIDS. And, by the way. there are FDA approved cannabinoid products available for these conditions.
And don't tell me that research has never been done on cannabis because of restrictions. The problem is that research has been done and that it has shown cannabis provides limited benefits for any conditions except nausea and vomiting related to cancer treatment and weight loss and poor appetite related to AIDS. And, by the way. there are FDA approved cannabinoid products available for these conditions.
2
What does it matter if the FDA has done double blind studies on marijuana for pain. If you really cared about studies on marijuana for the treatment of pain you could look them up on google. There's lots out there for your reading pleasure.
Tom,
First, of all the FDA doesn't do the studies. It reviews the studies done by others to determine if a medication is both safe and effective before approving it to be sold.
And the studies it requires are double blind studies, not anecdotal ones.
And you can google all you want and I challenge you to find any actual double blind studies demonstrating the benefits of marijuana for back pain.
If anecdotal evidence is sufficient to prove marijuana is effective for back pain then why do pharmaceutical companies have to spend billions of dollars to do double blind studies on their products for them to be approved. Either you have a system for medication approval that applies to all drugs or you don't.
First, of all the FDA doesn't do the studies. It reviews the studies done by others to determine if a medication is both safe and effective before approving it to be sold.
And the studies it requires are double blind studies, not anecdotal ones.
And you can google all you want and I challenge you to find any actual double blind studies demonstrating the benefits of marijuana for back pain.
If anecdotal evidence is sufficient to prove marijuana is effective for back pain then why do pharmaceutical companies have to spend billions of dollars to do double blind studies on their products for them to be approved. Either you have a system for medication approval that applies to all drugs or you don't.
1
Can't help but notice the footwear on the woman in the photo. Perhaps she should start by tossing off those heals and wearing more sensible flat shoes that wouldn't irritate her back problem!
8
Absolutely! Toss the shoes/boots!
1
I read with great interest your article on lower back pain. My wife has been suffering for over two months now. Aspirin , Tylenol, or opioids does not help. Exercise would be wonderful if she could walk more than a half a block. Surgery has been ruled out by two prominent spine surgeons. The only hope we have left is pain management injections. If the doctors that conducted the study have a solution for the problem other than exercise, we would like to know about it.
3
Recently, a doctor told me pain is OK. Another suggested modifying my activities all the while admonishing me to keep moving.
3
I hate opioids. They constipate me and provide just enough relief that I can shuffle around the house and sleep some at night. I have been through it all: acupuncture (I paid), PT (insurance paid), injections (again insurance), and three spinal fusions and need another operation; something called a Pedicle Subtraction Osteotomy which at 70 scares me more than the pain. I believe in exercise as a pain reliever. I used to walk five miles a day, but when it's pain beyond endurance then take two aspirin and don't call doesn't cut it. I get there is an opioid epidemic; but people in real pain didn't cause it but we are victims of it. The only reason I manage to get my monthly prescription filled is because my pharmacist knows my need is real. Dr. Damle may have some good insights; but he is also responsible for laws curbing painkillers for those like me who need them.
17
I retired from surgical practice of 44 years and residency training of 7 years. I have had low back pain in the past--many times--and never took opioid medications for this condition.
I support this article and its recommendations.
There have been many patients who became dependent on narcotic medications; a condition far worse than transient back pain.
Anyone vigorously supporting using opioids are most likely profiting from prescribing them. Not needed. Risk is too high and benefit too low.
I support this article and its recommendations.
There have been many patients who became dependent on narcotic medications; a condition far worse than transient back pain.
Anyone vigorously supporting using opioids are most likely profiting from prescribing them. Not needed. Risk is too high and benefit too low.
23
When my back issues became chronic and severe, the orthopedist and I settled on a conservative treatment plan consisting of physical therapy. The insurance company cut off the physical therapy before it had been completed, claiming, inaccurately, that there had been no improvement, and the physical therapists did not want to appeal as they have found that the insurance companies always reject the appeals.
I returned to the orthopedist and she scheduled an MRI that cost the insurance company over $1000. The MRI showed that I had four herniated discs -- information that was of no practical use whatsoever -- whereupon the insurance company paid for the rest of my physical therapy.
And we wonder why medical costs are soaring . . .
I returned to the orthopedist and she scheduled an MRI that cost the insurance company over $1000. The MRI showed that I had four herniated discs -- information that was of no practical use whatsoever -- whereupon the insurance company paid for the rest of my physical therapy.
And we wonder why medical costs are soaring . . .
174
@Josh Hill:
My current insurance is pretty good, but I remember constantly fighting with my old insurance over physical therapy for lower back pain. One would think physical therapy that strengthens muscles and teaches better posture would be the responsible and cost-saving long-term treatment...
My current insurance is pretty good, but I remember constantly fighting with my old insurance over physical therapy for lower back pain. One would think physical therapy that strengthens muscles and teaches better posture would be the responsible and cost-saving long-term treatment...
6
The same goes for psychotherapy. If the results aren't immediate or the patient isn't "sick enough" they cut it off. They prefer to have patients medicated even though that medication can cause physical problems that will, if the medication is continued, interfere with the patient's life in significant ways. Our so-called health care system for many ailments is really a crisis based system. As such it fails us when ordinary ailments like chronic back pain require physical therapy or any other sort of treatment.
4
As a physician with longstanding low back pain, this is exactly what I do. An orthopedist I know with chronic back pain does the same. Believe it or not, this is standard of care for uncomplicated low back pain. Just to be clear, not all lower back pain is uncomplicated. If there is progressive unremitting pain, weakness or incontinence it needs to be evaluated.
61
Sure, staying active helps, as does losing weight and strengthening core muscles. I do all of this and more, yet still slugger from chronic pain. please do not discount the fact that the pain is real and, at times, debilitating. I have scoliosis that has worsened in the past 3-4 years such that the former compensating curve is now permanent. All of my lower disks are herniated; I've had one diskectomy and am not a candidate for further surgeries unless I want a fused lower spine. I can distinguish between nerve pain, arthritic pain, disk pain. I suck it up every hour of every day. I cannot take NSAIDS, and I will not and cannot take opioids. Every time I read an article that says just get up and move, I want to scream. Please be a little more considerate when writing these sorts of stories. This is the most I've written about my pain, but your insensitivity really got to me.
144
Odd that Chiropractic was not mentioned in this article. I've seen a Chiropractor for years for back pain and it has always helped.
9
Whenever I suffer a back pain episode, my only course of action is to see a chiropractor. They work wonders and more people should consider them for pain relief and actual cure.
4
It was mentioned down towards the bottom.
1
“It is much easier at Mass General to get a shot than to get a mind-body or cognitive behavioral therapy,” he added.
Therein lies one of the big problems in our American healthcare system--a seemingly outright refusal (or at least turning a blind eye) to acknowledge any sort of noninvasive therapy. Instead, we are medicated and scanned (scammed?) to death. I am not faulting doctors here, but rather our insurers, who have only the shareholders or CEO's interests at heart.
Therein lies one of the big problems in our American healthcare system--a seemingly outright refusal (or at least turning a blind eye) to acknowledge any sort of noninvasive therapy. Instead, we are medicated and scanned (scammed?) to death. I am not faulting doctors here, but rather our insurers, who have only the shareholders or CEO's interests at heart.
25
As an emergency physician for 40 years, I'm well aware of the dangers of opioid abuse and excessive opioid prescriptions. But these guidelines go too far in the opposite direction. Have any of the authors of the new guidelines actually had low back strain for a couple weeks? The pain is too bad to exercise or do normal activities. Waiting it out is torture. Pain is easily controlled with 1 or 2 pills daily of a moderate opioid for 5-7 days which dramatically improves a patient's life. It's time to stop vilifying the use of all opioids for all conditions, when small controlled doses for a short time for acute, limited pain conditions are what they are best used for and provide great benefit to patients with almost no risk.
390
I am sure there are many instances in which the pain is so debilitating an opioid is the only choice. But I wonder how many of those cases you reference--a short-term 5-7 days regime--turn into long-term abuse. That is something that could be easily studied and reported on.
As a lay person, the problem I see with the short-term approach is after 5-7 days, the patient might well be experiencing severe, but manageable pain. How many people are willing to accept greater pain, after taking opioids? How many are willing to undertake time consuming, painful physical therapy when there is a pill that gave them relief?
Some people may be able to take short-term opioids and stop after a week, but obviously there are millions who cannot. The key is trying to determine prior to prescribing opioids who will fall in the group of potential addicts. If that is impossible, then doctors are playing Russian roulette with opioids turning patients into addicts.
Real research free of pharmacological influence is needed. Fat chance that will ever occur in our money driven medical industry.
As a lay person, the problem I see with the short-term approach is after 5-7 days, the patient might well be experiencing severe, but manageable pain. How many people are willing to accept greater pain, after taking opioids? How many are willing to undertake time consuming, painful physical therapy when there is a pill that gave them relief?
Some people may be able to take short-term opioids and stop after a week, but obviously there are millions who cannot. The key is trying to determine prior to prescribing opioids who will fall in the group of potential addicts. If that is impossible, then doctors are playing Russian roulette with opioids turning patients into addicts.
Real research free of pharmacological influence is needed. Fat chance that will ever occur in our money driven medical industry.
3
You're right about the recommendations going too far toward "stick it out." As a sufferer over the last 40 years with maybe a half dozen incapacitating episodes, I've found that a prescription anti-inflamatory for a few days along with a muscle relaxer at night, I was able to resume guarded activity in a couple of days. Why the macho endurance torture? Insane. Pills and shots don't make people addicts, willy-nilly prescription availability and abusive drug taking does.
4
Thank you. And take this with a wink, go to YouTube and listen to "Stop Making Sense" by the Talking Heads...loved that band.
1
As a layperson, it is disconcerting to see the degree of volatility in conventional wisdom on how to treat pain. Merely 10 years ago or so, the consensus view was to treat chronic pain aggressively and directly, allowing the body to heal unimpeded by the pain and inflammation caused by the injury. This included the opiod classes of medication, which today are anathema. Is there sufficient scientific knowledge of the physiology involved to provide truly informed guidance? Is this newest "trend" as much a reaction to the addiction epidimic as it is medical truth?
46
Not including Chiropractic or mentioning it demonstrates the limits of the the study's scope and its presenters.
22
They did mention it, down towards the end.
2
Chiropractic and acupuncture were some of the things mentioned in this article as well as exercise.
1
I hurt my back doing exercise that I had no business doing on my own. MRI showed three bulging discs and I could barely move. As a nurse, though, I knew I did not want back surgery with its low rate of positive outcomes (for me), and I absolutely knew that I did not want narcotic pain relievers. I was given a prescription for PT and to take over-the-counter anti-inflammatories. It took six months of physical therapy (I had a generous benefit at the time), all the while my therapist and I trying to figure out what would be the best thing [it was the aqua therapy that finally did the trick]) but it worked. I am not 100% pain free, but I know what works for me when it flares up and I can handle it.
I believe in order for this type of recommendation to work, insurance benefits for PT must be more generous. As I mentioned it took six months and trying several different things (manipulation, traction, different exercise programs that MUST be adhered to, and finally the pool) to get my pain manageable. I definitely exceeded most benefit limits for PT but I would venture to guess that my whole course of therapy cost a lot less than the surgery would have.
Oh, and another thing--the patient must be dedicated to this program for it to work. I had an exercise routine that I adhered to on a daily basis for over a year. People seem to want the easy way out, which is whatever medication will end the pain. PT works.
I believe in order for this type of recommendation to work, insurance benefits for PT must be more generous. As I mentioned it took six months and trying several different things (manipulation, traction, different exercise programs that MUST be adhered to, and finally the pool) to get my pain manageable. I definitely exceeded most benefit limits for PT but I would venture to guess that my whole course of therapy cost a lot less than the surgery would have.
Oh, and another thing--the patient must be dedicated to this program for it to work. I had an exercise routine that I adhered to on a daily basis for over a year. People seem to want the easy way out, which is whatever medication will end the pain. PT works.
30
I don't know why pool therapy isn't first recommended. It's so much easier on the body and therefore more efficient and effective for the patients. It took me years to be prescribed the best treatment I've had.
4
Agree, PT works, but it is seldom covered by insurance. Or is only covered short term.
1
After 3 years of 3x week therapy and treadmill, I am not pain free but pretty close. To suggest this half baked idea that one size fits all, and to dismiss the demoralizing effects of chronic back pain is just plain quackery. I am grateful for the effective pain pills that are available through prescription, as there is nothing OTC that comes close. Taken as needed and in partial doses, no addiction has been noted. Every patient has their own experience, and no one should be expected to tolerate pain for extended periods without relief.
134
As a 60 year old construction worker, and still too young to retire, I appreciate your full understanding of this issue in th micro, NOT macro sense.
2
At the age of 57 here, I have maintained a wall of separation between me and the medical establishment for 45 years now. Not even aspirin. I rely on millions of years of miraculous engineering contained within my own body to heal itself. And it does. Over and over again. I look at our "health care delivery" vehicle in the United States and can only conclude that it is motivated by less than pure intentions that confuse people and often leads them into a labyrinthe of unintended side effects and financial stress that only exacerbates their symptoms. I read this article and noted, "of course."
27
Not "Mike" - but spouse of Mike replying -
I'm...going to bet you've never been on the floor prostrate with the pain of a spasming back? Yeah. Maybe spare a thought for those that suffer. This doctor really didn't.
I'm...going to bet you've never been on the floor prostrate with the pain of a spasming back? Yeah. Maybe spare a thought for those that suffer. This doctor really didn't.
3
I agree that the less medication we take, the better.
On the other hand, good luck when you find the first symptoms of, say, shingles. A little anti-viral shot given ASAP goes a long way towards mitigating the worst effects of this unpleasant malady.
On the other hand, good luck when you find the first symptoms of, say, shingles. A little anti-viral shot given ASAP goes a long way towards mitigating the worst effects of this unpleasant malady.
And for those of us whose pain does radiate down the leg and has lasted more than 12 weeks, is there more information?
67
Right, sciatica or lumbar spinal stenosis. I've had two successful surgeries and went through a large range of non-surgical treatments first. I had disabling pain first in one leg, then in the other. There was very little actual back pain. Most of the treatments now recommended were useless and yoga was dangerous. If you have persistent leg pain, get an MRI - a pretty definitive diagnosis. There are relatively minor surgical interventions that might work - e.g., laminectomy. Steroids - either oral or shots - do work and opiates might provide relief although not much in my case.
1
I recommend that you rub some castor oil into your lower back and then apply a heating pad for 1/2 hour every day. This is a known folk remedy for back pain, and it worked for me.
1
That was my situation more than 15 years ago, and I ended up going to a surgeon for a micro-discectomy procedure. Best medical decision of my life. I woke up from anesthesia knowing instantly that the procedure worked and have had no pain since.
2
It is shocking to me how the medical community and their patients have turned their backs on known therapies that can offer dramatic relief from both pain and dysfunction. After having suffered with chronic low back pain since childhood, in my thirties I was referred to an osteopathic physician at the Clinical Center at Michigan State University.
While my relief was neither one hundred percent complete nor permanent after the very first treatment, the change was startling. The doctor had literally changed my life. In subsequent episodes of back pain, I returned to him and his colleagues and always got immediate and longlasting relief. The sad part of this anecdote is that not nearly enough students of osteopathic medicine opt to specialize in this life-changing therapy which can likewise offer real, tangible relief for other musculoskeletal disorders as well.
Now, living in Costa Rica, we are blessed to have access to a young couple who practice chiropractic. While it, too, is not a cure-all, the relief they have afforded my wife and me has made life comfortable whereas before both she and I lived in constant pain.
While my relief was neither one hundred percent complete nor permanent after the very first treatment, the change was startling. The doctor had literally changed my life. In subsequent episodes of back pain, I returned to him and his colleagues and always got immediate and longlasting relief. The sad part of this anecdote is that not nearly enough students of osteopathic medicine opt to specialize in this life-changing therapy which can likewise offer real, tangible relief for other musculoskeletal disorders as well.
Now, living in Costa Rica, we are blessed to have access to a young couple who practice chiropractic. While it, too, is not a cure-all, the relief they have afforded my wife and me has made life comfortable whereas before both she and I lived in constant pain.
15
You might be interested to know that Dr. Weinstein is a doctor of osteopathy.
Thanks for bringing up OMT! The Osteopaths near and dear to my hear thank you. I too have had treatment at MSU-COM, and from many students of that fine institution. It is a wonderful help for many sorts of musculoskeletal ailments, and MD's don't know much about it.
This method worked for me. I had back and leg pain due to bulging disks and spinal stenosis. I could not take NASIDS because I have GERD and I would not take opiates. I had therapy and continue to do the exercises every morning. It took over a year but my back and leg pain are gone.
24
How old are you? How long ago was the injury? How many disks are herniated? How far are they extending and how many nerve fibers are being touched and being enflamed?
These are just some of the questions hat need being answered. Also there is no cure but surgery for a portuding disk or keep dealing with the pain till the nerves dies. How much pressure is on the nerves and if pushed inwards, are they compressing the Cord stack which can lead to paralysis.
This is a juvenile level article with the author having very little knowledge of pain management and solution. This is the kind of hysteria that confuses people who trust your power blindly.
These are just some of the questions hat need being answered. Also there is no cure but surgery for a portuding disk or keep dealing with the pain till the nerves dies. How much pressure is on the nerves and if pushed inwards, are they compressing the Cord stack which can lead to paralysis.
This is a juvenile level article with the author having very little knowledge of pain management and solution. This is the kind of hysteria that confuses people who trust your power blindly.
2
So the method advocated in the article (NSAIDs, running and waiting it out) is not really what worked for you. What worked for you is physiotherapy. But it takes a good physiotherapist to teach appropriate exercises, and a good medical insurance or a chunk of money to pay for a full course of physio, something which is out of reach for many Americans and apparently will only get worse.
1
As an acupuncturist, I'm happy to read this. I've been helping people with back problems for many years. I'm not in a position to say that what I do is no better than a placebo, as Dr. Standaert suggests in the article, but my experience suggests otherwise. Truth be told, I've helped many people but not everyone. And as far as massage: there is massage and there is massage. Massage can be therapeutic in different ways; much depends on the practitioner as a person and the practitioner's approach. This is also true of acupuncture.
I like part of what Dr. Weinstein says at the end: “What we need to do is to stop medicalizing symptoms. Pills are not going to make people better and as for other treatments, yoga and tai chi, all those things are wonderful, but why not just go back to your normal activities?”
The problem is that it's often people's normal activities that are causing pain. How we use or misuse our bodies -- through habit or the demands of work -- leads to the problems that bring us to the doctor -- or the acupuncturist or other bodyworker.
Yes, it's critical to be active, and many musculoskeletal problems resolve themselves. Nonetheless, many will benefit from a nonpharmacologic intervention that helps break the cycle of pain, helps to heal injured tissue, and enables us to use our bodies properly again.
I like part of what Dr. Weinstein says at the end: “What we need to do is to stop medicalizing symptoms. Pills are not going to make people better and as for other treatments, yoga and tai chi, all those things are wonderful, but why not just go back to your normal activities?”
The problem is that it's often people's normal activities that are causing pain. How we use or misuse our bodies -- through habit or the demands of work -- leads to the problems that bring us to the doctor -- or the acupuncturist or other bodyworker.
Yes, it's critical to be active, and many musculoskeletal problems resolve themselves. Nonetheless, many will benefit from a nonpharmacologic intervention that helps break the cycle of pain, helps to heal injured tissue, and enables us to use our bodies properly again.
38
Wow. Talk about guidelines without any humanity in them. What should we do with these patients? Let's throw eggs at them.
As a healer for almost 20 years dealing with these patients, I call upon my powers to curse these doctors with 12 weeks of back pain to see if their opinion is changed. By the power vested in me. See if it's just more than "annoying" but ADL limiting, anxiety producing, and guarding manifesting.
BTW, my credential gives away my occupation. . .um, I don't think any of my treatments have bankrupted patients in my 20 years. Medical treatments - now they HAVE. Everyday. My fees ain't cheap though I suppose. ..but a veritable bargain compared to an urgent care visit or ER visit.
Meh. Maybe I'm a little defensive here. . .I don't mind being told to pull back on interventions, counsel a bit more (fan of cognitive behavioral therapy), intervene a bit less, but if the underlying message is to ignore it, my suspicion is the eggheads have never had a bout of it, and fully deserve a full bout for proper clinical perspective. Kidney stones pass too. . .doesn't mean a patient should just sit at home and drink a lot of water either.
Finally, needed moral lecturing aside, this kind of public health recommendation is a beautiful set-up for taking an innocuous condition and having it go full blown chronic. Pain is a funny bird. . .through neural plasticity it can take a life on of it's own if "simply ignored" by egghead recommendations.
As a healer for almost 20 years dealing with these patients, I call upon my powers to curse these doctors with 12 weeks of back pain to see if their opinion is changed. By the power vested in me. See if it's just more than "annoying" but ADL limiting, anxiety producing, and guarding manifesting.
BTW, my credential gives away my occupation. . .um, I don't think any of my treatments have bankrupted patients in my 20 years. Medical treatments - now they HAVE. Everyday. My fees ain't cheap though I suppose. ..but a veritable bargain compared to an urgent care visit or ER visit.
Meh. Maybe I'm a little defensive here. . .I don't mind being told to pull back on interventions, counsel a bit more (fan of cognitive behavioral therapy), intervene a bit less, but if the underlying message is to ignore it, my suspicion is the eggheads have never had a bout of it, and fully deserve a full bout for proper clinical perspective. Kidney stones pass too. . .doesn't mean a patient should just sit at home and drink a lot of water either.
Finally, needed moral lecturing aside, this kind of public health recommendation is a beautiful set-up for taking an innocuous condition and having it go full blown chronic. Pain is a funny bird. . .through neural plasticity it can take a life on of it's own if "simply ignored" by egghead recommendations.
72
Amen!
Have any of these authors experienced severe, debilitating, chronic back pain? It doesn't sound like it. I've been through all of the alternatives and for years physical therapy worked. But then it just stopped working. I guess the spinal stenosis, degenerative disk disease, arthritis, scoliosis, and spondylolisthesis I have are now best treated by ignoring them? I wish it were so because I'd love to get off of these pain relievers.
I can't believe these people. Incredible.
Have any of these authors experienced severe, debilitating, chronic back pain? It doesn't sound like it. I've been through all of the alternatives and for years physical therapy worked. But then it just stopped working. I guess the spinal stenosis, degenerative disk disease, arthritis, scoliosis, and spondylolisthesis I have are now best treated by ignoring them? I wish it were so because I'd love to get off of these pain relievers.
I can't believe these people. Incredible.
10
well, the pendulum swings. Concerning pain control (a subject all tied up with our puritan moral yearnings), it swings wide. Either we are telling people to take all teh narcotics they want, no problem, or we are denying that they have any pain at all. There has to be a happy medium here, but when the pendulum swings, it swings right past it.
2