Back pain might not be as inevitable as death and taxes, but it sure comes close. About 80% of Americans will have back pain at some point in their lives.
A troubling trend: Studies show that far too many people are now having surgery in an attempt to relieve back pain.
But only about 10% of all back pain sufferers actually need surgery. Even when pain is severe, the overwhelming majority of back patients will make a full recovery within two to three months with nothing more than painkillers, exercise, physical therapy or other conservative treatments.
Most people get their first episode of back pain in their 30s. But as we age, the incidence of back pain increases. With wear and tear, the spinal discs, which act as shock absorbers and allow the spine to flex, start to dry out and weaken (a condition called disc degeneration). This can result in painful back conditions such as a herniated disc, facet joint syndrome or spinal stenosis.
More about these back problems and the best treatments for them…
About 20% of adults have one or more herniated discs without symptoms, but others aren’t so lucky. A herniated disc is among the main causes of low-back pain and the “shooting” pain of sciatica.
As we age, the spinal discs lose some of their water content, which makes them more prone to tearing or rupture (a herniated disc). An MRI is used for diagnosis.
My advice: Unless you’re having serious neurological symptoms—foot or leg weakness, for example, or a loss of bowel or bladder control—wait at least six weeks before considering surgery.
The surgery for herniated disc, called a microdiscectomy, is frequently performed on an outpatient basis, is very safe and has a high success rate. But research has shown that about 90% of patients with a herniated disc will get better without surgery. There’s a good chance that the body’s natural healing mechanisms will break down the damaged portion of the disc, and the pain will clear up on its own. The catch is that it can sometimes take up to a year or more to recover.
Even though doctors often recommend steroids (oral or as an injection), many patients prefer a nondrug approach to pain relief.
A therapy that’s underutilized…
• Alexander technique. This is an especially good treatment choice for back pain or sciatica that is caused in part by poor posture or other issues involving body mechanics. It can also help some patients with spinal stenosis (see below).
With the Alexander technique, named after its inventor Frederick Alexander, a patient’s body movements are analyzed and then specific recommendations are made to relieve tension in the body and improve posture and movement.
Important finding: A study in BMJ involving 579 patients with chronic or recurrent low-back pain found that those who had six to 24 instructional sessions and practiced the technique had less pain than those given conventional treatments, such as massage and exercise.
Facet pain affects at least 15% of all people with back pain—and nearly 45% of back pain sufferers ages 50 to 60. It can be caused by trauma—twisting too hard during a round of golf or a tennis serve, for example—but it’s usually due to osteoarthritis in the spine. The facet joints are the round protrusions that you can feel when you touch your spine. Arthritis in these areas can cause pain and/or stiffness, just as it does in the knees or other joints.
Clues for facet pain: The pain usually comes on quickly…can make it difficult to stand up straight or get out of a chair…and may also cause pain in the buttocks or thighs.
If you have mild/occasional facet pain: I advise you to wait it out. Many people get better on their own within four to six weeks. While you’re waiting for the issue to resolve, you can take ibuprofen (Motrin) or other painkillers…avoid stressing the area…and try chiropractic treatments (they’re safe and can realign the facet joints to reduce pressure but avoid if you have severe osteoporosis or spinal cancer).
If you have severe/lasting pain: Ask your doctor about radiofrequency nerve ablation. It’s a simple surgical procedure that uses a microelectrode to destroy the affected nerve. In one important study, the procedure was found to reduce pain by 50% to 80% in most people. Nerve ablation is unlikely to cause complications, although the nerve sometimes grows back—and could cause pain in the future. Insurance usually covers the procedure.
With spinal stenosis, there is a narrowing of the spinal canal (the open space in the spine that holds the spinal cord), which can exert pressure on spinal nerve roots resulting in pain. Some people are born with a narrow spinal opening, but most often it’s caused by age-related changes such as arthritis or the growth of bone spurs in the spinal canal. Some people with spinal stenosis have low-back pain, while others have pain that radiates down the leg (it can be similar to the pain that’s caused by sciatica).
Clues for spinal stenosis: Pain increases when you walk and quickly gets better with rest. With sciatica, pain is sometimes relieved by walking. Also, if there is pain relief when bending forward (this movement “opens up” spinal spaces and reduces pressure), this points to stenosis. A diagnosis can be confirmed with a CT scan or MRI of the lumbar spine.
My advice: I almost always recommend surgical decompression for patients with spinal stenosis. One large study showed that people who have surgery recover more quickly and stay pain free longer than those who have physical therapy or undergo other treatments for spinal stenosis. The procedure is usually covered by insurance.
With surgical decompression, the surgeon removes the excess bone and overgrowth of ligaments that’s causing the pressure. It takes about three months for full recovery—but it’s one of the most successful spinal operations, with more than 80% of patients reporting good improvement. However, surgery can’t correct arthritis, so symptoms may eventually return. Risk for side effects is low but includes nerve injury and infection.
