Low Back Pain

Back pain. Just the words alone can make us shudder. It is one of the most common and problematic health conditions that we face in the United States and the Western world. During our lifetimes about 80-90% of us will suffer from one or more episodes of back pain. What is so infuriating and mysterious about back pain is that the ost severe pain often starts with the simplest of tasks. It can be as mundane as feeding the cat, bending over to tie ones shoes or sneezing.

Twenty-seven million people visit the doctor for complaints of back pain annually. In fact, it is the second most common reason we seek medical attention behind only the common cold.

The two most common behaviors that we directly control which increase the chances of disc degeneration and back pain are smoking and obesity. Smoking cessation, diet and exercise are the simplest and cheapest ways to limit risk of serious back pain.

MRIs and back pain

It is hard to believe, but disc degeneration can begin in some of us as early as age 10. Unfortunately, the term “degenerative disc disease” has been given to this process. It is not a disease, but what was described many years ago prior to our understanding of how our spin ages. It begins so early that when we obtain MRI studies of 18 year olds who have never had any back pain, up to one-third of them have degenerative discs and arthritis. At age 40, almost all of us who have never had any back pain have abnormal MRI findings. Remember these “abnormal” MRIs are in healthy, pain-free individuals. That is one of the things we do not understand: why people with severe MRI findings can have no pain, while others with essentially normal MRIs have terrible pain. It is why MRIs are often not very helpful in acute episodes of back pain and, in fact, can often lead to painful and unnecessary treatment. MRIs in new-onset back pain are often only necessary if there is serious trauma (falls, motor vehicle accidents, etc), concerns about cancer or significant nerve involvement.

Treatment options

The initial goal of treating acute or new-onset back difficulties is to treat the pain. This can be done by:

  • 2-3 days of bed rest (any longer than this only tends to lengthen the duration of pain)
  • Ice or heat, massage therapy, chiropractic management or acupuncture
  • Medications such as acetaminophen and anti-inflammatories which can be obtained over the counter.

If the pain is very severe, it amy necessitate a trip to the doctor or emergency room where muscle relaxers and even narcotic medications may be prescribed. During one of these visits, physical therapy or a referral to a pain management may also be prescribed.

It is important to remember that no matter how severe the pain and no matter how it started, great than 90% of all episodes of back pain are markedly improved within the first two weeks. It’s also important to remember that very few of us go on to develop the debilitating and disabling that we all fear, and even fewer require spine surgery.

Back pain is very common and fortunately usually very short-lived. Proper nutrition, exercise and smoking cessation can all help us avoid back pain and costly and painful procedures.

Source: By Thomas Doers, MD, Orthopaedic Surgery – Spine Surgery, Aurora Advanced Orthopaedics

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