Lower-back pain: Our readers rate remedies
Back pain is among the top three complaints I hear from patients coming to my neurology practice. By the time they see me, they’ve heard advice from their friends and family, and often their primary-care doctor, neurosurgeon, or orthopedist, each with his or her own (often conflicting) recommendation. They’ve also searched the Internet and read about an endless assortment of lower-back pain treatment options. No wonder they’re confused.
Study after study has shown a wide variation in the management of lower-back pain. If you go to your primary-care doctor, you’re likely to get an X-ray and a prescription for physical therapy. If you see a chiropractor, you’re sure to be treated with spinal manipulation. Anesthesiologists and pain-management specialists tend to favor injections, and many orthopedic spine surgeons and neurosurgeons lean toward surgery.
To illustrate how subjective your care may be, just take a look at the Dartmouth Atlas Project*. Medicare patients in some regions of the country were far more likely to have had back-fusion surgery than patients in other areas. For example, out of 10,000 Medicare patients living in Newark in 2002, about 4 had back-fusion surgery. In a similar group of patients living in Bradenton, Fla., that year, about 29 had back-fusion surgery—more than seven times the rate of surgery in Newark. Some regions had more than 20 times the rate of back-fusion surgery than in other areas.
Because lower-back pain treatment recommendations are often so capricious, Consumer Reports surveyed many of our own online readers, asking you to share your lower-back pain experiences with us. More than 14,000 respondents reported that they had experienced back pain sometime in the 12 months before taking the survey, and they shared their views on 23 possible remedies. The results surprised even me! Our report takes those experiences and combines them with a section on the medical evidence for each remedy (for subscribers), along with our recommendations and cautions.
In my practice, having informed patients is the best medicine, since the work involved in getting better takes time, effort, trust, and cooperation.
—Orly Avitzur, M.D., Consumer Reports medical adviser
*links to pdf
Posted by: Health blog | Sep 19, 2009 6:14:41 PM
I work with osteopaths and i see them doing incredible things everyday. Clearly they can help. Back pain is alwasy terribly complicated and tend to reoccurs because we use our backs for everything we do in life. Another aspect of back pain is that it build up with years.
Posted by: LuckyChucky | Jun 29, 2009 4:43:30 PM
First, I was very surprised that this article seemed to suggest that those with back pain first then do nothing, then go straight to considering surgery. Perhaps I am wrong but it is my understanding that the FDA strongly recommends trying a minimum of 6 months of therapy (Chiropractic or Physical Therapy) before even considering surgery. Just seems like would have been an important point to bring out to those looking for advise. At present a REAL clinical study is being done of mechanical distraction aka non-surgical spinal decompression. It is being conducted by SUNY (State University of New York). Randonized, double blind, and controlled. I understand that until this happens, this is considered "experimental". I also know of several doctors (MD's) who have already purchased these machines to place in thier clinics to have after the results are released. My father had back surgery and it helped him a lot. He is the only person I know who has had back surgery that I can say that about. Consider all options, and also consider who you take advise from. There are some very very exciting new spine surgeries that are available now that will increase the success rate a lot. A new spine surgery being done in Germany now will be available here is a couple more years. It will improve the success rate even more. But really folks, why would anyone have surgery if there are safer methods to try first? No I am not a chiropractor. Yes I do work with one. I also work with a D.O..
Posted by: orlando chiropractor | Jun 5, 2009 12:13:44 AM
Spinal Decompression has been growing in popularity for pain relief. I actually had 3 patients last month say they enjoy it better than the option of actually having surgery. But still a large percentage of the general public doesn't know what it is but it's a definite top option.
Erik Roach
http://www.orlandofamilychiropractor.com
Posted by: jerry krumbein | Apr 21, 2009 7:38:39 PM
I had severe spinal stenosis for 15 years, which, over the years, continued to worsen. An epidural injection every 5-6 months allowed me to continue to play high-level competitive basketball. Two years ago, the injections no longer worked. I then got a laminotomy (not laminectomy) performed by Dr. Josef Gorek in Oakland,CA Kaiser. Since it did not involve fusing or any "hardware," I was able to go back to playing basketball. According to Dr. Gorek, that surgical technique did not exist 10 years ago. I am glad I waited.
Posted by: kgmlc | Apr 21, 2009 10:51:22 AM
I don't understand how any discussion of back pain remedies can fail to include the work of Dr. John Sarno (identified incorrectly as Robert Sarno in April 7 post), of the Rusk Institute of Rehabilitation Medicine in Manhattan. His 1991 Healing Back Pain: The Mind-Body Connection explains the role of repressed emotions in causing this (real, not imagined) pain. After years of trying everything and seeing a chiropractor who was willing to treat me indefinitely, at huge cost, with no coherent explanation of what was causing the pain, I saw Dr. Sarno, attended his lectures, and was cured permanently of acute shoulder pain that had persisted for 15 years. Countless friends, relatives and acquaintances of mine have had the same results merely by reading the book. Dr. Sarno has a huge following in the NY Metropolitan area. The fact that his treatment plan isn't better known is a testament to the medical establishment's commitment to lucrative (however ineffective) treatments and costly drugs and its resistance to acknowledging the important role of emotions in physical health.
Posted by: Suffering | Apr 20, 2009 7:56:52 PM
I've been disabled with severe back, leg, neck, shoulder, arm, etc. pain for 24 years. For 5 years, I was told it was in my head. When I awoke one morning unable to put weight on my left leg, a Neurologist confirmed two herniated disks that he said were shown on the original x-rays. I think the only treatments I have NOT tried are the DRX-9000 decompression and surgery. Odds of surgical success of 50% did not appeal to me.
After traditional therapies not only failed, but made me worse (I developed sciatica following 'facet blocks'-injections into the spaces between the spine), I tried acupuncture with great success. The effects lasted for about a year, so I returned to the (Chinese) M.D. Physiatrist for another round. This time, it had no effect. I've since tried 3 well-respected acupuncturists without success. My Osteopathic manipulations have kept me from being completely bedridden; but my pain is often unbearable and untreatable. I've had allergic reactions to extended release pain meds (Opana ER and Fentanyl patches). I can't sleep at night because of pain and have tried almost every type of bed/bedding on the market.
To say that my pain is in my head is insulting, just as it was insulting 24 years ago. I've used meditation, biofeedback, ultrasound, PT, hot and/or cold packs and exercise. Now, I'm in too much pain to exercise and have respiratory problems. I take multiple pain meds but have managed to avoid increasing the dosage except in extreme circumstances. I don't like the side effects and have cut way back on what I take. But I must take something.
I'd love to find a non-pharmaceutical solution, but so far I haven't found any (not for lack of trying). My doctors are out of ideas as well.
Posted by: Jan | Apr 20, 2009 7:48:21 PM
Acute and chronic pain are distinct...and what works for acute may not be appropriate or effective for chronic pain. Any successes to share with the modalities discussed for relief of Chronic Regional Pain Syndrome (CRPS)?
Posted by: Ross | Apr 20, 2009 6:33:29 PM
I completely agree with the person who recommended Dr. Sarno. I was in extreme pain for almost 6 months and this helped tremendously. Howard Stern dedicated Private Parts to this doctor for ridding in him of his back pain.
He is a professor at NYU's school of medicine, but I just read and followed his books and it helped.
Posted by: Judy Nagy | Apr 20, 2009 6:18:17 PM
One of the most overlooked causes of lower back pain - and not mentioned in this article is Ankylosing Spondylitis, a rheumatic condition. It is much more common than MS, for instance, and yet gets little attention.
I suffered for years until I was finally diagnosed by a competent Rheumatologist. Until then, I spent thousands of dollars on alternative treatments such as chiropractic, acupuncture, massage therapy, decompression, TENS, ultrasound, etc., etc. While many did help, they never treated the underlying disease itself which continued to worsen.
There are new medications for those suffering from Ankylosing Spondylitis. http://www.spondylitis.org is the offical site for this disease and is an invaluable resource for more information for both patients and physicians. It's helped me immeasurably.
Please be aware that this type of arthritis usually manifests as lower back pain, and yet so often is not even considered as a possibile cause.
Posted by: bill | Apr 20, 2009 6:16:38 PM
I am an active 40 year old male and having multiple back/sciatica issues for past 20 years, my experience tells me that, like most health issues, where the body manifests the pain is not the source of the problem (hence, our dismal track record in healing). In other words, we seem to treat the symptom rather than the cause. I have had about seven years now of no back pain due to basic yoga once a week, attention to posture if at desk for work, and avoidance of sugar and processed foods as much as possible that can lead to inflammation. It seems that two issues, increasing blood flow to muscles as well as minimizing lactic acid buildup, often can lead to healing if you can find the proper professionals to help guide you. Otherwise, nothing else seems to work over the long term. There is no magic drug or surgery, but for those of us with chronic problems, it requires a lifetime commitment to above.
Posted by: Dorothy Gallardo | Apr 20, 2009 6:08:49 PM
I am a 65 yr old female who has had a lower and upper herniated disk
for about 30 years. My orthopedic instructed me as how to keep the pain at a minimum. Muscle relaxers on occasion. Today I use no medication
except for rainy weather flare ups. Usually Robaxin or aspirin.,
I row on my rower for 40 minutes a day, 6 days a week while leisurely watching tv. Then I hang upside down for 3-4 minutes on a Orthopod.
I have used the Orthopod for sciatica attacks as well.
My orthopedic surgeon is also my brother in law and I trust him.
Posted by: myna lee johnstone | Apr 20, 2009 5:13:10 PM
What a DUMB statement: no such thing as lower back pain!
When the cartilage in the lumbar joints wear out and when there is arthritis it can be EXTREMELY painful.
Go sell your mind over matter somewhere else, PLEASE.
Posted by: Dr. Howard I. Flum, Chiropractic Physician | Apr 13, 2009 12:13:38 PM
I am a chiropractor in Brookline, MA. In 1998, I had a very severe car accident which caused, among other injuries, several disc herniations in my lower back. For almost 5 years, I had significant pain in my back and legs. During this time, I underwent many different treatments, including: chiropractic, PT, massage, acupuncture, biofeedback, meditation, pain and sleep meds, stress counseling, epidural injections, and even percutaneous laser disc surgery. Finally, the condition improved.
Last October, I re-injured one of the affected discs in my lower spine. After receiving chiropractic care, acupuncture, massage, and attempting to do stretching and other exercise, by the end of the year I was on pain meds and unable to sit for more than several seconds at a time.
Because the condition was so painful, I had gotten to the point of seriously contemplating surgery, which had been recommended by the ER physicians, my physiatrist/pain specialist, the doctor doing spinal decompression on me, and even by my chiropractor. Fortunately, once again through a combination of treatments, I seem to be recovering without the surgery.
However, this recent incident really caused me to consider certain assumptions about health and chiropractic care. First, that there are a wide variety of chiropractic techniques. In school we all learn a few, and may pick up some others through various seminars and classes. Most chiropractors, after a few years in practice, hone what they know and distill it down into their own "special brand" of technique. But the truth is, some techniques work better for certain conditions than others, and some chiropractors are simply better at what they do.
In my case, although my chiropractor is fantastic and is in every sense "a chiropractor's chiropractor" with this particular exacerbation, his treatments provided only temporary help for me.
I finally decided to see another chiropractor, who happens to be one of my mentors, and has been retired for some time. I consider him to be one of the best living chiropractors that I know personally. He is much more specific in his approach, and that’s what made the difference for me. Now, each adjustment builds on the last and I'm actually improving rather than feeling only temporary relief.
My point is that if you've tried chiropractic care for a particular condition and haven't seen optimal results, don't give up. You might just need another chiropractor and/or a different technique. Call or e-mail any chiropractic college for local referrals. Check out various chiropractic websites to learn more about the various techniques, what their differences are and to obtain referrals. Check out different chiropractors' websites for any information that may help you to understand your condition a little better. You could even ask your own chiropractor or other health care professional whom they go to see!
There is always an answer to why you have a particular problem, and if you look hard enough, almost always an adequate solution!
Health, love and happiness,
Dr. Howard Flum
Chiropractic Physician
Posted by: Stan Jacobs | Apr 10, 2009 10:30:13 PM
I've found help with chiropractic, compression shirts, and Biofeedback or Neurofeedback.
Posted by: Dr. RBW | Apr 10, 2009 8:15:28 PM
The quality medical research suggests that "Traditional Chinese Medicine" Acupuncture is NO MORE EFFECTIVE than "Western" Acupuncture . . . in fact, studies have demonstrated the EXACT same benefit whether you follow the traditional "meridians" or not. I agree, give it a try! It seems to help folks.
Posted by: Peter Demarest | Apr 10, 2009 9:40:50 AM
I have used accupuncture for back pain and a number of other issues. In fact, I have long considered Acupuncture and Chiropractic as my primary care. I could give you numerous stories including how Acupuncture and Chiropractic totally solved problems for which medical doctors wanted to do surgery. To your specific question about Acupuncture for back pain: Try it! I would do recommend that you go to someone who is fully trained in Traditional Chinese Medicine, not just Acupuncture.
Posted by: Ken Wilkins | Apr 9, 2009 4:57:16 PM
Acupuncture for back pain? Anyone who has tried it, please comment.
Posted by: Lee | Apr 9, 2009 3:11:29 PM
Kind persons,
Are there any comments on your site about Cervical Spinal Stenosis? I am interested in having dialogs with persons who have or had this problem. Drs say a lot but I need to discuss with actual sufferers.
Thank Yoy
Posted by: KEVIN MARISAY | Apr 8, 2009 10:13:07 PM
i noticed that the title "OSTEOPATH" was never mentioned in this report..........
Posted by: mick99 | Apr 7, 2009 10:13:20 AM
Anyone suffering from lower back pain should be aware of Dr. Robert Sarno and his mind-body connection theories. I personally suffered from lower back pain for years. It turns out that there is nothing in your lower back that would cause pain and that unless you've been crushed in an accident, lower back pain is caused by stress and once a person "gets it," the pain disappears. If you go to a doctor and are shown an x-ray that explains your pain, the doctor won't mention that millions of folks have the same spot on their x-ray and suffer no pain at all. The true beauty of Dr. Sarno's work is that it requires no doctor visits, no medication, no exercises and no purchases at all. You can gather enough material on his website so that you need not buy his books although he does deserve your support. In fact, if you have read this posting, you know all you have to.