I just returned from vacation, and after an eight hour flight home, my lower back has been a little sore this week (thank you Lufthansa for the cramped seats!) Which got me thinking about the topic of low back pain, and that I have yet to comment on it on this blog.
Back pain is one of the most common conditions we see in adult primary care. It is also one in which the western model of medicine really falls down. To explain what I mean by this, let’s consider two other common diseases, and then consider back pain:
UTI (Urinary Tract Infection): is caused by a bacteria in the bladder. To diagnose this, we can test a urine specimen and find the specific bacteria that is causing the infection. We can then give an antibiotic that acts against that specific bacteria. The result is that the UTI will be cured.
Heart attack: is caused by a blockage in a coronary artery. If you make it to the hospital in time, a team of cardiologists will put a catheter into your heart and inject some dye so that they can see inside your coronary arteries. They will be able to see which artery is blocked, and then put a stent into that area to relieve the blockage. While the outcome is less certain than with a UTI, most patients who undergo this procedure will recover well, and often go on to live for many more years.
Note the pattern to the above two issues. In each case, it is possible to identify exactly what the problem is, and to give a therapy that specifically targets that problem, which in turn completely solves the problem.
This pattern does not apply to the vast majority of cases of back pain. Consider just a few points:
Multiple studies have shown that MRIs of the spine often lead to abnormal findings even in people who do not have any back pain.
Studies also show that many people who do have back pain have normal MRIs. So a blocked artery equals a heart attack and vice versa, but an abnormal MRI of the back does NOT equal back pain, nor vice versa.
Multiple studies show that, in the long run, back pain outcomes are often similar in patients undergoing aggressive (e.g. surgery) versus more conservative (time, rest, physical therapy) treatments. In other words, a person who is having a heart attack that isn’t treated is likely to die within a few days, but a person who has a back injury that isn’t “fixed” will probably do about as well as a person who has back pain that is.
None of this means that back pain isn’t often due to an injury of some type. Just that in many cases, back pain seems to be a more complicated issue than simply “you have a bad disc here, and therefore your back hurts here.” For this reason, millions of people are walking around with chronic pain in their back that no doctor has been able to fully fix.
Faced with this dilemma, it’s important to take a more comprehensive look at back pain than simply doing an x-ray or MRI and blaming the pain on a disc issue or arthritis. Here’s a brief overview of my approach to this issue.
First and foremost, I take a history and examine the patient to make sure there isn’t anything more serious going on (not that back pain isn’t in and of itself serious, but it’s important to not miss the very small number of back pain cases that are due to things like tumor, infection, a fracture, or an autoimmune disease). Depending on the circumstances, this is the moment when things like an x-ray, blood work, or an MRI may be helpful.
Fortunately, most people with back pain will not turn out to have any major underlying disease, which is great news. Unfortunately, it also means we will be stuck with the same limited range of treatment options (pain medications, physical therapy, chiropractic care, acupuncture, massage) that don’t always work.
Here’s where taking a more holistic approach can be helpful. While this is not an exhaustive list, the following treatments (often in combination with the standard of things like PT and pain relievers) can be very helpful:
Red light treatment: I’ve covered red light treatment in a prior post. Treating back pain is one of the top things we use our red light device for here at Dr. Fischer, MD, and this is an included service (as needed) for all of my patients. Often, just a few sessions brings major relief of symptoms.
Foundation training: a patient of mine from my old practice in RI who was himself a chiropractor turned me onto this one. Foundation training is a series of yoga-like back exercises developed by a chiropractor named Dr. Eric Goodman. Fortunately Dr. Goodman has a free twelve minute workout on youtube. Over the years, I’ve found both for myself and for my patients that a few days in a row of doing this exercise program often leads to tremendous improvements in back pain and sciatica. Click the link here to watch this video at no cost.
Better sleep: I’ve covered how to sleep better in a series of prior posts. Studies have shown that poor sleep acts as a “pain amplifier” leading to worsened pain. If you are having chronic back pain (or any type of pain really), it’s worth optimizing your sleep as best you can, as this can lead to less pain over time.
Healthy diet: at the risk of sounding like a broken record, much of the processed food consumed in this country is highly inflammatory and can worsen pain issues. Cleaning up your diet can often lead to much less pain.
Meditation: several studies have shown reduced pain in people who meditate regularly.
I’d be lying if I said that the above was a completely satisfactory approach. Many people who do all of the above and more will still have some degree of pain, at least some of the time. But I find that most patients who pursue these measures have better outcomes and feel like they have more control over their pain than those receiving the “standard primary care approach” of simply taking an Advil and doing PT when their back pain flares up.
