Four common mistakes in back pain treatment

Four common mistakes in back pain treatment

Why you probably don’t need an MRI, strong drugs, bed rest, or back surgery

Published: August 2014

With back pain, less really is more. Up to 90 percent of people who see a doctor in the first three days of a back attack get better within two weeks, regardless of what they do. Aggressive tests and treatments can waste your money and actually slow your recovery. Here are four common mistakes in treating back pain—and what to do instead.

Mistake 1: Rushing to test

Back pain can be so intense that your first thought might be that you need an X-ray, CT scan, or MRI to see exactly what is going on with your spine. But most people who have those tests within a month of the onset of pain don’t get better faster and might get worse. Why? Scans often show small abnormalities that aren’t the cause of the pain but can prompt you and your doctor to pursue unnecessarily aggressive care. Worrying about those abnormalities might also increase your perception of pain and make you hesitant to stay active, which is a key to recovery. In addition, X-rays and CT scans expose you to unnecessary radiation. One study estimated that the 2.2 million CT back scans done in 2007 will lead to 1,200 future cancers. Read more about when imaging tests for lower back pain are needed.

CR’s take: Resist the urge to ask your doctor for an imaging test. If he suggests one, ask why. Good reasons include pain that doesn’t respond to self-help methods in a month, leg weakness, pain radiating from the buttock to a leg, a recent fall or accident, a history of cancer, and unexplained weight loss.

Mistake 2: Lying down

For decades, doctors recommended bed rest for back-pain sufferers. But a 2010 review found that patients advised to stay active reported less pain and a faster recovery. And new guidelines say that doctors should urge patients to resume normal activities as soon as possible and caution against staying in bed for longer than four days.

CR’s take: As soon as you can, try some low-impact activities such as stretching and walking. Then move on to exercises that strengthen your abdomen, back, and legs. Seeing a physical therapist to learn proper exercise technique can be a good idea. But don’t expect too much from passive treatments, such as ultrasound and transcutaneous electrical nerve stimulation, or TENS, that are included in some physical therapy sessions.

Mistake 3: Taking the wrong drugs

Doctors prescribe almost a third of back-pain sufferers potentially addictive narcotic pain drugs such as oxycodone (found in OxyContin and Percocet) and hydrocodone (found in Lortab and Vicodin). But people who take the drugs report more disability after six months compared with those who don’t. And the longer you use an opioid, the higher the dose you’ll need. That increases the risk of addiction and side effects, and makes it less likely that the drugs will help if you do need them, such as after surgery.  

There’s another treatment to question: steroid injections. Some doctors prescribe them for pain related to osteoarthritis, but there’s little evidence that they help for anything other than back pain with sciatica (leg pain from a pinched nerve). Even then, effects wear off by three months.

And last, there’s nothing special about so-called backache pills such as Doan’s. They usually contain the same or similar ingredients found in other over-the-counter pain relievers.

CR’s take: Start with generic versions of over-the-counter ibuprofen or naproxen. They’re just as safe and effective as brand-name versions, including Advil and Aleve, and they’re cheaper. But those drugs can cause cardiovascular and gastrointestinal problems, so stick with generic acetaminophen if you have heart disease, stomach ulcers, or gastritis. If that doesn’t work, consider a prescription muscle relaxant, such as generic cyclobenzaprine.

Mistake 4: Having needless surgery

The number of back surgeries continues to rise each year. A 2013 study of Medicare patients found a 214 percent increase between 2000 and 2010. “There’s this perception that back surgery must work since it’s so expensive and requires so much recovery time,” said Roger Chou, M.D., a back expert and director of the Pacific Northwest Evidence-Based Practice Center at Oregon Health & Science University. But it often doesn’t. That’s partly because back pain often stems from arthritis, poor posture, weak muscles, and similar problems that can’t be fixed with surgery. Even when the pain is caused by such conditions as a herniated disk or spinal stenosis (a narrowing of the spinal column), conservative treatment is often enough.

CR’s take: Consider surgery if you have severe back and leg symptoms clearly linked to a herniated disk or spinal stenosis that hasn’t improved with conservative treatment in three months. Even then, surgery might not be the best option. “I tell my patients that while surgery can help them feel better faster, they can still get there—albeit more slowly—without surgery,” Chou said. If you and your doctor decide you do need surgery, use our hospital Ratings to compare the hospitals in your area on surgical complication rates and other measures.

Alternative treatments for back pain

There is limited research that the following therapies might help some people. Consider trying one if basic self-help steps don’t work. Asking your doctor for a referral may make it easier to get insurance coverage.


• Spinal manipulation (pictured) can be done by a chiropractor, an osteopath, or a physical therapist. Go to the American Chiropractic Association, the American Osteopathic Organization, and the American Physical Therapy Association for more information.


• Massage reduces muscle stiffness and might prompt the release of pain-relieving endorphins in your brain. Go to the American Massage Therapy Association and National Certification Board for Therapeutic Massage & Bodywork to learn more.


• Acupuncture appears to help some, and not just because of the placebo effect, research suggests. Go to the American Academy of Medical Acupuncture and the American Academy of Acupuncture and Oriental Medicine.


• Viniyoga, which combines breathing techniques, simple postures, and deep relaxation, may be the most effective form of yoga for back pain. Go to the American Viniyoga Institute.


• Cognitive behavioral therapy helps you recognize and change negative feelings and thoughts related to chronic back pain. Go to the Association for Behavioral and Cognitive Therapies.


 


Editor's Note:

This article also appeared in the September 2014 issue of Consumer Reports on Health.



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