Low back pain, one of the most common ailments of man, is the second most common reason for visits to the doctor. Studies indicate as many as 85% of people will have back pain in their lifetime.
There are many causes of low back pain, including:
Evaluated on the RESCU Rating Scale
R = Risk E = Effectiveness S = Self-Care
C = Cost U = Usefulness (overall rating)
1 = Least Favorable 5 = Most Favorable
| R | E | S | C | U | |
| Chiropractic | 5 | 5 | 2 | 4 | 5 |
| Ice/Heat | 5 | 3 | 5 | 5 | 5 |
| Acupuncture | 5 | 3 | 1 | 5 | 4 |
| Cortisone Injection | 1 | 2 | 0 | 3 | 1 |
| NSAIDs | 2 | 3 | 5 | 4 | 3 |
| MuscleRelaxants | 3 | 2 | 0 | 4 | 2 |
| TENS | 5 | 3 | 5 | 5 | 5 |
| Surgery | 3 | 2 | 0 | 1 | 3 |
| ElectricalStimulation | 5 | 2 | 4 | 4 | 5 |
| Exercise | 4 | 5 | 5 | 5 | 4 |
It goes without saying that the type of treatment you receive for your back pain will largely depend on whom you see. Generally, it makes sense to start with the least invasive, safest and more cost effective treatments first and work up from there.
Your M.D. will likely provide anti-inflammatory medications, muscle relaxants and pain medications initially. If those fail to resolve the problem, he or she may refer you for physical therapy, and more and more frequently these days for chiropractic care or acupuncture. If conservative care fails to resolve the problem and there is a disc herniation, or pressure on the spinal cord or a nerve, you may be referred to a pain specialist for epidural steroid treatments. Less common problems will require various forms of care tailored to those conditions. Ultimately some conditions will require surgery if nothing else helps.
The first step in developing a plan of treatment for low back pain is understanding the nature of the problem. Most low back conditions are considered non-specific or mechanical. Providers of different types tend to look at low back pain from their own perspectives. For example, orthopedic surgeons may evaluate patients to determine if their condition will respond to surgery. Pain doctors will often suggest medications or epidural injections and family physicians typically rely on anti-inflammatory medications and muscle relaxants.
Some providers, such as chiropractors , will evaluate patients to rule out more serious conditions, but tend to focus on mechanical dysfunction of the joints or muscles. Acupuncturists use a different paradigm which evaluates for blockages of Chi or energy channels in the body’s meridians.
Physical therapists evaluate for muscle or joint dysfunction or deconditioning of the muscles that support the spine. Other providers, such as naturopaths, may use a combination of natural remedies including herbs. Physical therapists and others including chiropractors, naturopaths, some physicians and acupuncturists will also use therapies, modalities and procedures to help relieve back pain. These might include electrical muscle stimulation to reduce pain and relax muscles, traction, soft tissue muscle techniques, and a variety of other conditions.
Most providers will agree that exercise is an important component of any treatment problem for low back pain. Most chiropractors, physical therapists and many M.D.’s will provide exercises to their back pain patients.
Your provider will screen you for potentially life-threatening conditions which might present as back pain. These might include infection, fractures, and malignancies. Factors such as advanced age, heavy use of steroids and significant trauma increase the risk for fractures. Tell your provider if have any of these issues, or a previous history of malignancy.
In the past, most people with back pain received x-rays early in their treatment plan, and often received other imaging studies such as CT or MRI. Research eventually demonstrated these studies were rarely necessary early on, and in fact led to more tests, more costs, and more invasive procedures, including surgery, which also were usually not necessary. Most low back patients can defer these studies while they undergo a trial of treatment. If “Red Flags” are present, or you don’t respond as expected, then imaging studies make sense. If your provider wants to take x-rays or send you for CT or MRI, ask them why, and what they hope to learn from the study. Ask what the downside to waiting might be, and how the imaging study would change their treatment approach. If they plan to do the same thing regardless of whether a study is obtained, hold off on the study.