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The Truth About Back Surgery

So What Does Help? continued...

Over-the-counter anti-inflammatories like naproxen (Aleve) and ibuprofen (Advil, Motrin) can reduce pain. In an extensive set of treatment guidelines issued by the American College of Physicians (ACP) and the American Pain Society (APS) in 2007, these meds were found to offer "moderate" benefit. While that may not sound encouraging, prescription painkillers also came in as "moderate."

Your goal is to stretch and strengthen back muscles, which can bring significant relief as you ease tightening and spasms. The same ACP/APS set of guidelines found that exercise therapy and yoga, with its emphasis on stretching and body control, are the best workouts for back-pain sufferers. But don't "stretch through" or "push beyond" anything truly painful. A physical therapist can show you how to exercise safely and for the most benefit.

Spinal Manipulation
Some people swear by chiropractic treatments; others are skeptical. And the scientific evidence is just as mixed. A 2004 review of 39 randomized, controlled studies published by the Cochrane Collaboration found that "spinal manipulation was more effective in reducing pain and improving ability to perform everyday activities than sham therapy." But, the researchers concluded, "it was no more or less effective than medication for pain, physical therapy, exercises, back school, or the care given by a general practitioner" for patients with acute or chronic lower-back pain. If the pain's in your neck, think twice about chiropractic; it's rare, but neck manipulations can trigger a stroke.

Epidural Injections
Many women are familiar with epidurals, having experienced the shots' pain-numbing relief during childbirth. For backs, injections generally contain an anesthetic (like procaine), as well as a steroid (like cortisone) to calm inflammation. Epidurals can't cure back problems, but they may buy you some pain-free time while the disc has a chance to heal and shrink. Relief tends to be modest and short-lived (three months at most).

In a recent, well-designed study of 638 patients with chronic back pain, those who received acupuncture (10 treatments over seven weeks) improved considerably more than a group receiving continued "usual care" (no special treatments — just medications, physical therapy, or whatever they'd been doing). Even after a year, the acupuncture group was significantly better off. But here's a surprise: Simulated acupuncture (stimulation of acupuncture points with a toothpick in the traditional needle-guide tube) turned out to be as effective as the real thing. Researchers speculate that stimulation of acupuncture points without breaking the skin — or a placebo effect — provided the relief.

Going Holistic
Multidisciplinary programs teach everything from rigorous exercise to meditation — and have impressive success rates. At the Texas Back Institute's CoPE (Conquering Pain Effectively) program, for example, patients boost their mobility 50 percent, on average, while cutting their pain in half and their painkiller use by 75 percent. When Theresa Hesse of Mesquite, TX, went to CoPE in 2006, she was relying on strong painkillers in order to stay involved in family activities with her two kids. "I'm emotional and loving and busy, but I was just going through the motions," says Hesse, who'd had three failed back surgeries. The CoPE program is intense — 40 hours a week for four to six weeks; in the supervised setting, Hesse was able to work hard rebuilding strength she'd lost from years of protecting her back. Participants are also taught biofeedback, meditation, and other techniques to deal with pain and the depression and anxiety that often accompany it. Today, says Hesse, "I still have to use some pain medication — things are pretty messed up in my back — but I can live my life."

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