We Obey Pain

We are inundated with information about back pain. That’s because so many of us experience it, and pain is something that we obey. Here are some statistics from the American College of Rheumatology that will grab your attention: 80% of the world’s population develops back pain; the back-pain price tag for the U.S. alone is $50 billion dollars a year; and next in line to a cold, back pain is the second most common health affliction.

Despite these startling facts, most episodes of low back pain resolve within a couple weeks and over 90% will be resolved in eight weeks. As a health consultant and having previously operated a fitness and wellness business, a common inquiry I have been asked is: “What should I do for my back?” My answer is: “Move it.” Researchers are discovering that non-surgical approaches for treating back pain are typically the most effective. These approaches include exercise, back maintenance programs, rehabilitation or alternative treatments such as massage therapy, acupuncture/acupressure, chiropractic work, etc. 
            The big question is always: “Is my back pain the result of a serious problem, or not?” Contrary to what people believe, herniated discs are common and are found in people who are functionally normal and without pain. By the age of sixty, it is estimated that between 80-90% of the population has some sort of disk degeneration (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854598/). Most back pain resolves on its own or with self-treatment. You may feel the need to ask for advice. You typically do not have to begin with any testing; the diagnosis of low back pain can be determined by medical history and examination, which will paint the picture as to the seriousness of your back condition (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495170/). When do you need further medical investigation and testing?  The first step is to pay attention to your body; we often know when “something is not right.”  If you have experienced back pain before, you can compare the difference. If your pain is accompanied by other symptoms such as fever, weight loss, weakness, neurological complications, etc., or your pain increases significantly and is not resolved in 7 to 8 weeks, then medical evaluation and diagnostic testing are usually warranted.
            Dr. Hamilton Hall (Canadian neurosurgeon and author of several books) is known as the “back doctor.” In his book, A Consultation with the Back Doctor, he states that he “despairs” that so many people are given misinformation and useless recommendations about treating their back problems, especially acute back pain. Our backs are not that fragile. In his book, Dr. Hall states: “Except for major injuries, there are very few things that you can do to physically harm your back.” The most important principle for back pain management is to keep moving. Conservative treatment (done correctly) will not make things worse. With acute back pain, rest may be necessary for two to three days; but certainly after four days, rest is of no value, and can actually be detrimental.
            Your car doesn’t run without oil; the back will not operate as you need it to without back maintenance. Back maintenance is necessary for prevention of pain, but it is especially needed for people who experience acute pain episodes, recurring back pain, chronic pain and for those who have had spinal surgery. It all begins with exercise or physical activity. The key elements of a physical activity regimen are developing a strong core, strengthening the back muscles, the leg muscles, and staying flexible in the torso and hamstrings. In addition to physical activity, a healthy back requires a healthy weight range (extra weight takes a toll on our back, and everything else). Be mindful of the activities you carry out in everyday life. Repetitive movements, especially in the wrong position, can contribute to back pain. A healthy back requires good body mechanics and good posture. Much of our back pain is caused by poor alignment; maintaining good posture (sitting, standing, sleeping) will reduce strain on the back. We are also a stressed-out society. Our bodies react to negative stress in many ways; our backs and necks are prime targets. Volumes have been written about stress and back problems. Thus, practicing relaxation techniques is also helpful for pain (see my website for relaxation techniques).
            What role does surgery play?  Surgery has its place. However, people often choose surgery because they are frightened, in pain, see no other alternative, and are guided in that direction. There is a vital question to ask: “Is surgery necessary to resolve my pain”? Let’s face it, when we are in pain, we obey it: we are often desperate and/or vulnerable, as well as fearful that there is an underlying serious condition. That is not necessarily the case. Certainly, there are conditions (and pain is a symptom) that require surgery: cysts, tumors, congenital anomalies, fractures, etc.  But only two out of a hundred people will benefit from spine surgery if it is being done to resolve back pain, and surgery is definitely not the answer for mechanical back pain, unless there are complications (Hall, Hamilton, MD, A Consultation with the Back Doctor).  These mechanical disorders include muscle strain, osteoarthritis and some degenerative problems, spinal stenosis, herniated discs, and conditions that involve excessive bone growth. These conditions respond much better to the alternative approaches previously discussed, not surgery. People are sometimes led to believe that a spinal fusion, which is even a more complicated surgical procedure, is the solution for their pain. However, the exact cause of back pain is not easy to determine and Dr. Carragee, Director of Stanford’s Orthopedic Spine Center, claims that less than 25% of spinal fusions, when done for back pain, are completely successful. Spinal fusions are beneficial procedures if the diagnosis is spinal cancer, scoliosis or a fracture.
            The decision to have surgery should not be based on the degree of pain. Surgery should depend on the ability to accurately identify the source of pain and successfully eliminate the symptoms. According to Dr. S. Waldman at NY’s Hospital for Special Surgery Pain Division, eighty-five percent of the patients with lower-back pain cannot be accurately diagnosed. It is often assumed that pain is a result of herniated disks or some degenerative processes seen in the diagnostic work-up. Again, not necessarily. Even with these conditions present, your source of pain may be from muscles, joints, ligaments, etc. Contrary to what people believe, it is challenging for doctors to determine the exact source of the pain. My experiences in the health field lead me to believe that it is very likely that the therapy and back maintenance programs, which take place after surgery, are the real forms of treatment. An important research area: “Is back surgery really working and is it the correct choice of treatment?” 
            There are many benefits of non-surgical interventions for back pain and this has been well documented. Pain is a complicated field of study. Pain can also lead to what is called “pain-driven behavior”. When a person has chronic back pain, there is often a pattern of self-destructive behavior. Of course we want to be pain free, but the reality is that we may have to learn how to manage our pain. Some people choose surgery as a means to relinquish responsibility, but you pay a price for that approach because you are essentially “turning over your back to the doctors.” The basic responsibility of caring for your back rests with you (A Consultation with the Back Doctor). You have to make a choice: Do you want to take charge of your life and design a strategy to manage your back, or do you want your back to rule you?