Back pain is pretty much ubiquitous. It is estimated that 80% of planet earth’s human population will have back pain at some point in time. While this may seem troubling, it is really no cause for alarm. Back pain is a normal part of life just like a common cold. What is troubling are the statistics about our country’s ineptitude to treat low back pain. We are currently spending approximately 100 billion dollars a year on treating low back pain and yet, people aren’t getting better, they are actually getting worse. How can that possibly be in a time where we have laser surgeries, advanced imaging and pharmacologically advanced medicines? The fact is, this back pain epidemic might not be in spite of those medical advancements but because of them.
In the past when a patient with back pain would gingerly sit down in my office, I would explain that surgery is rarely the answer, medications don’t fix the problem they just mask it and that diagnostic imaging rarely, if ever, accurately diagnoses back pain. When this information comes from a guy who can’t prescribe meds, can’t take an x-ray due to his state practice act and certainly can’t perform surgery, he is rarely looked upon as a reliable resource for information. Yet, all the research points to these facts, which is why I regularly and openly share it with my patients. However, sadly, what I say is usually cast aside and physical therapy is done out of obligation to the patient’s physician rather than any type of intrinsic desire to help their body naturally heal itself.
The next few paragraphs are all about the current solutions we regularly utilize as treatment for low back pain in the US. I am going to paraphrase what an investigative journalist by the name of Cathryn Jakobson Ramin wrote about in her book Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. She has eloquently put the research into palatable form but the conclusion that she came to is due to the research that is and has been out there FOR YEARS. I hope this blog gives you greater insight to what is really going on.
Spinal Fusions
One of my teachers in graduate school, Dr. Tim Flynn a well-respected researcher and educator in the world of physical therapy, once referred to spinal fusions as the “modern day Labotomy.” Spinal fusions, on average cost $80,000 and carries with it a 35% success rate. If that number sounds low, that is because it is. Those who are most likely to benefit from the surgical intervention are young athletic individuals not the person who is more commonly getting the surgery – 54 year olds. While being young does help, research has shown that even after a successful surgery you are likely to end up on painkillers 2 years later.
Spinal fusion is extreme so it probably is assigned to people with extreme diagnoses, right? Nope. One of the most common low back pain diagnoses associated with this surgery was “nonspecific,” literally meaning, “I have no clue why your back hurts.” This is particularly disturbing since the diagnosis implies there is no specific cause of the low back pain, yet a very pointed, very specific surgery is being performed to stop one or more segments of your back from moving. This begs the question, “If you don’t know what is wrong with my back, why are you operating on it?”
Still not convinced that spinal fusions are a bad idea? A 2009 poll taken at a conference in Bonita Springs, Florida found that 99 out 100 surgeons who were asked if they would elect to have a lumbar fusion surgery if it were recommended to them said, “absolutely not.” That should tell you something.
Spinal Decompression
The research for this procedure is a little more favorable and it does have a lower price tag. However, data at the two year mark shows that outcomes for having the surgery are the same as NOT having the surgery. The pain that goes away with the surgery may have more to do with the fact that there is a lot of rehab after the surgery. Combine that with the fact that disc herniations go away by themselves (click here or here for more info) and you may have found the real reason for success in the first place.
What Is Wrong With Me
This is a question that EVERY ONE with back pain asks. They want to know the specific structure(s) responsible for their misery. The reality is that 85% of people with low back pain cannot get a true diagnosis. “Nonsense,” you say. I had an MRI/CT Scan/X-ray of my back and my surgeon found all sorts of things that were “wrong” with me. The fact of the matter is, according to research and Ms. Ramin, there are loads of people walking around right now with the exact same degenerative changes as you have and yet they feel NO PAIN. As Dr. Flynn liked to say, “Degenerative changes of the spine are the gray hairs and wrinkles of our insides.”
No Magic Bullet Or Pill
In early 2017, the American College of Physicians issued new guidelines to your physician advising them NOT to give out pain medications for garden variety (remember that is 85% of us) low back pain. In fact, opioid medications have only been found to be effective for people with pain caused by cancer. On top of that, there is also research that says long term usage of opioids can actually INCREASE your pain and your chances of becoming addicted.
Pain does not equal injury
One of the most common beliefs that persists in society at large is that when your pain flares up, you are causing damage to your spine. This is simply NOT TRUE. When you have back pain, it is imperative to exercise because motion is so vital to you and your spine’s health. Although exercise may hurt a little in the beginning, exercising with a trained professional like a doctorate-level physical therapist can help ease your pain and get you back to feeling like your old self.
Take home message
There are loads of conservative measures one should take before ever considering surgery or even opioid painkillers. Although I am extremely biased on what works for people with low back pain, I do recognize that there are literally millions of people who feel better from lots of different alternative treatments. Whatever works, I’m for it. What I do suggest is that you try as many conservative treatments first (exercise, ice/heat, seeing a physical therapist, etc) before you commit to more permanent measures (you know what I’m talking about.) In the mean time, if you have questions about your low back pain and want to feel better now, give me a call at 479-268-6040 or email me your question at doc@thatstheknot.com
