YONKERS, NY — Hands-on therapies are among the top-rated treatments for people suffering with back pain according to a new survey by the Consumer Reports Health Ratings Center.  Fifty-eight percent rated chiropractic/spinal manipulation as helping a lot.  And massage (48%) and physical therapy (46%) were close runners up.  Consumers also rated their satisfaction with practitioners, telling Consumer Reports they were more likely to be “highly satisfied” with the back pain treatment received from their chiropractors (59%) than from their primary-care physicians (34%). 

About 80 percent of U.S. adults have at some point been bothered by back pain.  To compare which treatments helped most, Consumer Reports surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. Consumer Reports asked its subscribers to rate a comprehensive list of potential remedies along with their satisfaction with the health-care professionals they visited.  Most respondents had tried five or six different treatments on average.  In a special online report at www.ConsumerReportsHealth.org, the Consumer Reports Health Ratings Center analyzes the medical evidence for each of 23 treatments side by side with consumers’ experiences and provides recommendations and cautions.  The site includes a free diagnostic tool for back pain.   

Here are some survey highlights:

• The percent of people highly satisfied with their back-pain treatments and advice varied by practitioner visited:

• Many of the respondents to the Consumer Reports survey said the pain interfered with sleep, sex, and efforts to maintain a healthy weight.  Eighty-eight percent reported that their back pain recurred through the year.  And over half of survey respondents also reported that low-back pain severely limited their daily routine for a week or longer.
• Forty-four percent of survey respondents found exercise helpful, making it the top self-help measure.  And a surprising 58 percent of respondents wished that they had done more exercises to strengthen their backs in the past year.  
• Although lower-back pain is the fifth most common reason people go to a doctor, 35 percent of the people surveyed by Consumer Reports said they had never consulted a professional.  Most of them had severely limiting pain for less than a week. Many of those with more prolonged pain who didn't see a health-care professional said it was because of cost concerns or because they did not think professional care could help.

Concerns About Rising Use of Narcotics

Forty-five percent of those who took prescription drugs said they helped a lot.  More than fifty percent of those given a prescription drug received an opioid pain reliever, despite the fact that there is very little research to support their use for acute low-back pain. “There are almost always better solutions than opioids for low-back pain. They have numerous adverse effects such as drowsiness, respiratory depression, constipation, and nausea, to name a few.  And overdose is a big concern, sending increasing numbers of patients to emergency rooms as opioid prescriptions rise,” said Dr. Orly Avitzur, a board-certified neurologist and medical adviser to Consumers Union.  Dr. Avitzur discusses her concerns about narcotics in her “5 Minute Consult,” available online at www.ConsumerReportsHealth.org.

Getting Treatment

When back pain is severe, a visit to a primary-care doctor is a reasonable first step.  A doctor can help rule out disease, such as infection or cancer, and refer a patient to a hands-on practitioner who might be covered by health insurance. 

Using self-help approaches to ease the pain or seeing a chiropractor or physical therapist as a first step might be okay for a recurrent, familiar back problem.  Research suggests that chiropractic manipulation can reduce acute low-back pain, and many, though certainly not all, of the respondents who tried it said it helped.  

Use Caution with Surgery

If back pain is unrelenting and no other treatment has seemed to work, a doctor might suggest seeing a surgeon.  Consumer Reports conducted a separate survey of almost 1,000 consumers who had back surgery in the past five years. 

Those who had back surgery had tried nine to 10 treatments and described themselves as much more impaired by their pain than people with back problems who did not have surgery.  Just 60 percent of the back-surgery respondents were completely or very satisfied with the results.   But satisfaction depended on the diagnosis and the type of surgery.  Those with degenerative disk disease (arthritis of the spine) were far less likely to be highly satisfied with surgery (54 percent) than those with a herniated disk (73 percent) or spinal stenosis (71 percent).

But not everyone does so well.  More than 50 percent of respondents reported at least one problem with recovery, finding it lengthier and more painful than they had expected.  The most common regret was that more post-surgery rehabilitation was not planned. Indeed, 16 percent of back-surgery respondents said that their back pain did not improve, and half of those said it became worse after surgery. 

Consumer Reports advises patients that are told they need surgery to get a second opinion from another practitioner, preferably one who is not a surgeon.  If surgery is the best approach, find out if the selected surgeon is board-certified and ask how many operations he or she has performed.   Patients should be aware that significant problems during recovery may be underestimated; it helps to have plans to adjust to such challenges.  

A summary of the survey is available in the May 2009 issue of Consumer Reports. 

About The Consumer Reports Health Ratings Center
Consumers have come to trust Consumer Reports’ ratings of thousands of products and services for the expertise and independence they represent.  The Consumer Reports Health Ratings Center uses similar approaches to produce ratings tables, selecting the best sources of research to rate health-care services, drugs, devices, institutional providers, and eventually physicians and other practitioners.   The Health Ratings Center (www.ConsumerReportsHealth.org) currently provides Best Buy Drugs (BBD) ratings on prescription medications for more than 20 common medical conditions; a wide array of healthy living products such as sunscreens and gym equipment; thousands of natural medicines; and treatment options for more than 200 conditions and diseases.