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."
He says he is not opposed to short-term spinal manipulation therapy because it may help with pain relief, but he cautions against "going to a chiropractor who says that you will need a treatment once a week for the rest of your life to avoid a return of symptoms. That's just not needed." He also says that he is opposed to a common practice by chiropractors of "routine total spine X-ray. Again, this isn't needed and is an unnecessary radiation exposure."
Asked whether corsets or support garments can help, Deyo says that the best studies suggest there is no benefit, but some people find them helpful. "If a patient tells me that something works, then I tell the patient to go for it." He says, too, that there is "very little science behind the so-called orthopaedic mattresses, and the advice about firm mattresses or bed boards really probably has more to do with a caution about avoiding sagging mattresses, which may make movement difficult."
Finally, Deyo says, the best way for doctors to treat people with back pain is to assure the patients that they will most likely get better soon and to follow up that advice with tips about strategies for limiting further episodes of back pain.
For example, patients with desk jobs should be urged to "get up and move around every hour or so," he says. People should also consider exercises that extend and flex the back, to strengthen the muscles. But the best advice is to "avoid activities that bring on symptoms. A few years ago, I found that running brought on back pain, so I switched to biking."