date: 5/2/2007
How to relieve stubborn back pain
Noninvasive treatments for back pain are often just as good if not better than surgery for treating stubborn back pain. ConsumerReportsHealth.org helps you sort out how to determine which alternative therapies are safe and effective.
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When back pain is disabling and prolonged, surgery may be offered as a treatment. While that makes sense in a few cases, recent evidence suggests that many people can get just as good—or even better—results with noninvasive treatments that they can do largely or entirely on their own. Good results come from using a targeted exercise program plus psychological or mind-body methods, which can not only ease stiffness and pain but also overcome back patients’ counterproductive fear of movement. Immobility can worsen a back problem by causing the loss of up to 3 percent of muscle function in just one day.
GENTLER TREATMENT

A two-year study in a November 2006 issue of the Journal of the American Medical Association found that people with a herniated disk and low-back pain got just as much pain relief from nonsurgical rehabilitation as from surgical removal of the damaged part of the disk. With both treatments, most of the relief occurred within the first three months.

In another study, in a May 2005 issue of the British Medical Journal, spinal-fusion surgery, often used to stabilize the spine after disk removal, was compared with noninvasive treatment. This involved intensive exercise plus cognitive-behavioral therapy, which helps people replace negative thoughts (such as “I’m never going to get better”) with positive ones (like “I will do all I can to help my back pain get better”).

The therapy also helps to relieve accompanying depression, which tends to increase sensitivity to pain. The noninvasive treatments were as effective as the surgery in easing pain, improving mobility, and helping people to resume work.

In addition, an analysis of the pooled results of numerous studies, published in the January 2007 issue of Health Psychology, indicated that cognitive-behavioral therapy or mind-body methods, with or without exercise, significantly reduced long-standing back pain compared with routine treatment using other techniques, including acupuncture, massage, and various injections. Effective mind-body methods include:
  • Hypnosis and subsequent self-hypnosis. Those make you receptive to images or ideas such as, “My back muscles are relaxed and pain free” or “I’m able to move about and do things normally, without any pain.”
  • Biofeedback, in which electrodes on your back generate visual or auditory signals that help you learn to relax tightened muscles.
  • Relaxation methods, such as meditation and breathing exercises, which stimulate the release of pain-deadening endorphins and reduce levels of stress hormones that can magnify pain.
Note that proper exercise is essential for treating back pain: It can build back muscle, boost flexibility, increase endorphins, and ease depression.
WHEN SURGERY CAN HELP

Back surgery is worth considering in three circumstances, according to our medical consultants. The first is when there’s a serious spinal disorder, such as a tumor, infection, or fracture. The second is when the pain is accompanied by a neurological problem in the legs that’s clearly related to a low-back abnormality on an MRI or CT scan. The third is when disabling pain in the back, buttocks, or legs is clearly linked with an abnormal scan and persists for six weeks or more despite conservative treatment.

But when a doctor recommends surgery and there’s no emergency, it may pay to get a second opinion from another surgeon or a physiatrist (a physician who specializes in rehabilitation).
INDIVIDUALIZED PLAN

For noninvasive treatment of stubborn back pain, it makes sense to get an individualized treatment program by consulting a physiatrist, physical therapist, or team of experts at a multidisciplinary pain center. The plan should include a gradually increasing exercise regimen: stretching, strengthening, and low-impact aerobic exercise, such as walking or swimming.

Psychological or relaxation methods should also be part of the plan, especially if you’re depressed or can’t overcome the fear that exercise will cause further pain or injury.

Acupuncture, massage, Pilates, spinal manipulation, and yoga may also help relieve back pain and speed recovery. When seeking such alternative treatments, heed your personal preferences. Research suggests that the strongest predictor of how you’ll respond to any back treatment may simply be whether you have confidence in the remedy. In one study that compared acupuncture with massage, for example, back-pain sufferers who expressed enthusiasm for their assigned therapy before starting were five times as likely to experience substantial benefits as the initially skeptical volunteers.


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