Healing a Bad Back Is Often an Effort in Painful Futility

NY Times ^ | 9 February 2004 | GINA KOLATA

[shrinkermd]

Treating back pain costs Americans $26 billion a year, or 2.5 percent of the total health care bill, according to a new study from Duke University, and far more if disability payments, workers' compensation and lost wages are taken into account. The costs are rising, researchers say, as patients get ever more aggressive forms of treatment.

Back problems are the leading reason for visits to neurologists and orthopedists and the eighth leading reason for visits to doctors over all — ahead of fever, knee pain, rashes, headaches and checkups for healthy babies. More than 70 percent of adults suffer back pain at some time in their lives, studies show. A third have had it in the past 30 days.

Yet for all the costs, for all the hours spent in doctors' offices and operating suites, for all the massage therapy and acupuncture and spinal manipulations, study after study is leading medical experts to ask what, if anything, is doing any good.

A variety of studies have suggested that in 85 percent of cases it is impossible to say why a person's back hurts, said Dr. Richard Deyo, a professor of medicine and health services at the University of Washington. And most of the time, the pain goes away with or without medical treatment.

"Nearly everyone gets better, nearly everyone improves," said Dr. Deyo, citing evidence from large epidemiological studies. But he cautioned, "Getting better doesn't necessarily mean pain-free."

"For a small number of patients," he added, "surgery can offer quick relief, although even then it is common to have mild symptoms and recurrences."

The Duke researchers, led by Dr. Xeumei Luo, used national data from 1998. Back pain expenses, they say, included $11.1 billion for office visits; $4.5 billion for hospitalization; $3.9 billion for prescription drugs; $4.7 billion for outpatient services; and $1.1 billion for emergency room care, with the rest made up of such things as medical devices. The total, $26 billion, was a 30 percent increase from 1977 after adjusting for inflation.

"It's not like there's an explosion of new back pain," said Dr. Steven Atlas, an assistant professor of medicine at Harvard Medical School, who investigates back treatments. "The number of cases isn't increasing; the cost per case is increasing. There is a lot more that is being done, but the issue is, Is it helping or not?"

Back pain has always been around, like headaches, or the common cold. What has changed, doctors say, are people's expectations.

"People say, `I'm not going to put up with it,' " Dr. Deyo said. "And we in the medical profession have turned to ever more aggressive medication, narcotic medication, surgery, more invasive surgery."

But studies find little evidence that patients are better off for all the treatment.

[shrinkermd]

FYI

[camle]

they know what is wrong with my back, but there ain't a think they can do about it. When it flares up, they give me drugs, and I'm out of action for about a week, but that's about all.

[Mark Felton]

My wife has had two neck surgeries, both of which were absolutely necessary and resulted in tremendous improvement.

The pain was excrutiating and debilitating but once her arms began to go numb surgery was the only option.

It worked.

Currently, she is suffering pain from another cervical location and has had a nerve rizotomy (ablation) which gave significant relief (several months ago). But symptoms are now returning.

We are avoiding surgery, unless motor nerve damage begins to occur.

[Blzbba]

I went to the doctor last week for some ridiculous lower-back pain. He told me that almost 90% of herniated disc problems 'fix themselves' within 6 months.

That was news to me and not helpful since mine involves a pinching of the sciatic nerve. Physical Therapy will probably be my next step.

The problem with 'traditional' medicine's approach to back pain is that, with my experience anyways, it's simply a prescription for pain relief/muscle relaxants and maybe some stretching. They don't appear to want to actually 'do' anything to address what CAUSES the pain.

Chiros aren't a bad option, if you can find one that isn't interested only in getting you to make 15-20 visits. I found one who wasn't and he seems to have fixed my upper-neck pain, caused by an auto accident.

[verity]

Once had an orthopedic surgeon tell me that man was never built to walk upright.

[PBRSTREETGANG]

Someone should talk to Dr. Howard Dean about this. His back healed almost immediately after his Army physical and he was soon able to ski difficult terrain in the Rockies.

[Solson]

I'm currently dealing with two herniated discs in my back. I don't have any idea when they came on or why but I've had one epidural which offered some relief, am scheduled for my second epidural tomorrow, stretch about 10 times a day, hang on an inversion board which definitely helps, and take 750mg of Vicodin every 4 hours.

It's going on two and one half months now and is a royal pain in the tail. I'll wait on the surgery for the time being...

[Solson]

I've got two herniated discs with strong sciatica down my right leg. Go get the epidural before you do any PT. It will help. Also, get an inversion board to allow your back to stretch and loosen.

But, your doc was right. Herniations take care of themselves in 6-8 months. The actual herniation is absorbed back into the body over a period of time. Meanwhile, it hurts like hell and is a royal pain.

[Blzbba]

Thanks for the advice! I'm supposed to be hearing from Doc any day now concerning the results of my X-Rays taken last Thurs. We'll see what he says. Where do I get an 'inversion board'?

[camle]

Well, I never let other people tell me what to do...

[Solson]

I found mine at Sam's Club believe it or not... It is a LifeGear inversion table and cost $150. Otherwise, look to the net for one. There are a few manufacturers, Life Gear, Kettler, Hang-ups, etc. but Life Gear seems to be on the low end. Since this was my first foray into hanging upside down like a bat, I decided to go cheap and see if it worked. It certainly helps.

[goodnesswins]

I was in an auto accident that caused about $10K damage to our Ford Explorer (back in 1992)....got hit once from behind, once on the side (I was waiting at a stop light)....needless to say I had NECK PAIN from whiplash....went to physical therapy, etc....they said I would likely NEVER be able to bicycle again....the pain was obnoxious whenever in a car, too....UNTIL...my husband bought me a Mountain Bike for my birthday....we went riding for about 16 miles....came back with bad neck pain, iced it. Went to bed that night....woke up the next day, and for all practical purposes have NOT HAD ANY PAIN since about 1993. Moral of the story.....backs and necks are weird.

[Chess]

What about torn disc? My husband has 2 of them after falling from a ladder. No two doctors agree on what he should do. Right now he is on pain meds which give a little relief, but he still cannot stand or sit for more than 15 minutes. He is too young to be in this condition (40's)

Anyone have any info on torn or ripped discs?