Northwest Health Fall 2012

Managing Back Pain

The best course of treatment for this common condition may surprise you.

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Twenty years ago, Matt Babcock took a summer job in building maintenance. The fit 22-year-old was accustomed to physical labor, but he began to have agonizing back spasms. After the initial episodes, even sitting in a chair could trigger his back pain. "I became increasingly depressed because I couldn't do things I wanted to, like sculpture and running," reflects Babcock. "For six years, I was sore, miserable, and almost hopeless."

Babcock, a Group Health member, is among the approximately 50 percent of Americans who experience back pain each year. For many of those, the pain will recur. In fact, back pain is the second most common reason for missed work.

The causes of back pain, however, are hard to pin down. A sedentary lifestyle, jobs with manual labor, being overweight — all of these things may contribute to nonspecific back pain, the type most people experience. More than 85 percent of back pain is considered nonspecific with no signs or symptoms of an underlying disorder. Nonspecific back pain is either acute, lasting a few weeks, or chronic, continuing for longer than three months.

Whatever form it takes, when there is no clear disease or disorder to correct, doctors can't easily make back pain go away. That can make dealing with it a discouraging process. Group Health member Jessica Westerhold experienced this firsthand. After she fell and hurt her back in 2004, Westerhold spent a year going through X-rays, CT scans, and MRIs. "It was really frustrating. The specialists kept telling me there was nothing they could do," she says. "Fortunately, my primary care physician was understanding and kept on encouraging me."

Grant Scull, MD, a family physician at our Capitol Hill Campus, says that doctors need to partner with patients to make sure they don't feel abandoned. "It's very stressful to be in pain. We want to acknowledge your suffering, reassure you, and give you the information you need to maximize the probability of a good result."

What Can Help

Evidence now suggests that for many back problems, conservative treatment works as well as more aggressive treatment. "Doctors have used injections, opioid prescriptions, imaging, and surgery. But evidence shows that these methods are usually not helpful in nonspecific back pain," says Randi Beck, MD, a physical medicine and rehabilitation physician at our Capitol Hill Campus. "It's important that doctors connect with the patient early on to make sure there's nothing serious going on, but 90 percent of patients feel better on their own in a few months." If you have an episode of acute back pain, avoid bed rest and continue as many of your usual activities as you are able, advises Dr. Beck. And try to keep a positive attitude.

Dr. Beck was a member of a Group Health team that recently reviewed studies on back pain and its treatment, and developed guidelines for the most effective treatments.

Recommendations for Care

Based on what they found, the team came up with new recommendations on how to best help patients deal with back pain. The recommendations recognize that self-managed care is critical to improvement for nonspecific back pain. Some of the best ways to handle it are within easy reach.

Dull the pain. Use heat or ice and acetaminophen or nonsteroidal anti-inflammatory drugs to help ease the pain.

Get moving. There is strong evidence that exercise can reduce back pain and even alleviate reccurring episodes. Aerobic exercise, stretching, and walking are just a few of the movements that can be beneficial. Your doctor can help you identify which exercise programs will increase strength and flexibility to manage back pain.

Westerhold's doctor said her lack of activity made her back worse and urged her to start an exercise program. "Even light exercise was painful at first but I did just a little more each time," recalls Westerhold. Exercise eventually allowed her to get off the pain medication she'd taken for years. "Now when I start to get twinges, I get up and walk around, and that loosens the spasm and dissipates the pain."

Regardless of the type of exercise you choose, a 2005 Group Health Research Institute (GHRI) study revealed that it's critical to stick with it. "Everyone needs to start slow and increase activity gradually, but the important thing is to find something that works for you and keeps you engaged so you can continue to lead a high-quality life," says Michael Von Korff, ScD, GHRI senior investigator who was involved in the study.

Recognize emotional stress.  Studies have also shown that depression and stress — like job dissatisfaction, financial difficulties, and upsetting family issues — can make your pain seem worse. Fear that your back pain is serious or due to an undiagnosed disease can affect your ability to get better as well.

Shifting your expectations about the pain can help you cope. Matt Babcock says he is learning to adjust his expectations. "Now I can say 'Yes, I'm having sharp pain today, but this isn't going to last forever and it doesn't have to disable me in the long term.' But this learning process has been gradual and ongoing."

Goal-setting improves progress.  The 2005 GHRI study also found that chronic conditions like back pain can be improved with goals and an action plan. When participants were given education to reduce fear about back pain, set clear goals to regain normal activity and quality of life, and developed an action plan to achieve those goals, it reduced both pain and inactivity.

Take preventive steps. There are things you can do to lower your risk of developing back pain. "Don't smoke, get regular exercise, do regular stretching, and use good lifting techniques to protect your back so you don't put unnecessary force across your lower spine," says Dr. Scull.

Factors that increase your risk of developing back pain include a sedentary lifestyle, being overweight — which places more internal load on your spine — doing manual labor, and smoking.

When to See the Doctor Right Away

Although most back pain is benign and will get better, 1 percent to 5 percent of cases are accompanied by indicators that may signal serious conditions and urgently require a doctor's examination:

  • History of cancer
  • History of osteoporosis
  • Immune suppression (steroid use, HIV, transplant, IV drug use)
  • Numbness in the groin area, weakness, incontinence, or urinary retention
  • Suspicious fracture
  • Inflammatory disease
  • Unexplained weight loss
  • Fever
  • Recent infection, such as a urinary tract infection
  • Progressive weakness
  • Abnormal gait
  • Back pain that doesn't respond to varying positions and hurts even when lying down


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