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Low Back Pain Is Inevitable, Expert Says

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Moreover, a backache is rarely a once-in-a-lifetime event, says Deyo, who is a professor of medicine at the University of Washington, in Seattle. And although the annual price tag for low back pain is estimated at $50 billion, Deyo says much of that is spent on unnecessary treatments.

He says that left alone -- without bed rest, spinal manipulations, or surgery -- low back pain will usually ease within a few days, or at worst, a few weeks. This was illustrated dramatically in 1988, Deyo says, when "Isiah Thomas of the Detroit Pistons suffered a back injury during the NBA playoffs. The next day, Thomas [was in so much pain he] could not get out of bed, and then two days later, he returned to lead his team to a victory."

Low back pain, Deyo tells WebMD, should be considered a chronic condition that may flare up in response to injury or overuse.

Deyo shared his approach to treating low back pain at a recent meeting of the American College of Physicians-American Society of Internal Medicine, an organization that represents many of the nation's primary care physicians.

Although many doctors believe that all patients with low back pain require an X-ray, Deyo disagrees. "In only 1 in 2,500 adults will an X-ray detect something that wasn't suspected by the initial physical exam," he says. Moreover, he says, when the lower spine is the focus of an X-ray, reproductive glands are exposed to high levels of radiation. "Getting a spinal X-ray is the equivalent of a daily chest X-ray for several years," Deyo says.

People with low back pain should have a thorough physical exam, rather than an X-ray, he says. For example, if the doctor finds pain shooting down the patient?s leg, known as sciatica, there is probably pressure on a nerve, he says. This condition may require surgery, he says. But he prefers to observe these patients on a weekly basis for a few weeks before referring them to a surgeon.

To illustrate his point, Deyo cites a case of a patient close to his heart: his wife. "She called me one day at work and said she had tingling in her heel," he says. "By the next day this had developed into full-blown sciatica with foot drop [or weakness]. She was actually catching her foot on the stairs." His wife, also a physician, decided to "wait it out. Within a few weeks, the foot drop and the other symptoms cleared."

Similarly if raising and crossing your leg causes pain, this "indicates that there is very likely a herniated disc." Herniated discs do not require surgery, says Deyo, who adds that after age 60, "36% of the population has herniated discs, but those herniated discs do not cause pain." Deyo says that although 60% of adults seek treatment of back pain, only "about 1% to 2% of these cases go to surgery, and even that may be more surgery than is really necessary."

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