It’s no secret that back pain is one of the most common health problems in the U.S. Treatment of low back pain costs over $50 billion every year, not counting the loss of time and productivity from work. Four out of five people will have back pain serious enough to miss work or reduce their activities at some point in their lives.
Men and women are equally likely to experience low back pain, most commonly between ages 30 and 50. Younger people who are still pliable just don’t know yet how much damage they’ve already done, and it seems to settle down somewhat in older individuals.
If back pain could be spotted on a screen, like an infected appendix, we would hear much less cussing and discussing about healthcare costs and delivery of care. Treatment of low back pain, both acute (recent) and chronic (persisting for three months or more) gobbles an inordinate share of medical dollars. But when you’re the one with the pain—unable to get out of bed, cut off in mid-sentence by a spasm that takes the breath out of your lungs, or stooped over the vegetable bin, unable to straighten up without pulling the shelves out of the refrigerator—there’s nothing inordinate about wanting to be rid of this aching, burning, stabbing or shooting pain now!
The human spine is arguably the most amazing mechanical and electrical device ever known. Physicians who specialize in the diagnosis and treatment of back pain appreciate its complexity and know from experience that what works for one person may not work at all for another. The process of figuring out what can go wrong with it has become an industry of its own. Because of the cost and the frequency of dealing with acute low back pain, hundreds of studies—and studies of studies—have been conducted over the past 30 years.
The evidence from all this research tells us uncomplicated acute low back pain is a problem that does not require extensive, expensive testing or intervention. It may hurt like heck, but it will usually go away. So why go to the doctor at all? In fact, most people don’t. They tough it out and try to deal with the pain—until it resolves itself or stops them from functioning.
The kicker in this is “uncomplicated.” The challenge for the doctor is to be able to tell which very small number of people actually need to be checked out for a potentially serious problem. Red flags that may indicate a more complicated condition include:
- Unexplained fever or weight loss
- Pain when coughing
- History of cancer
- Significant trauma
- Loss of bowel or bladder control
- Progressive weakness in the legs, etc.
With no red flags and nothing about the person’s general health or medical history suggesting anything other than typical low back pain, there is a decision point where medical “best practice” guidelines need to come into play. These guidelines indicate there is no need for X-rays or CT scans for uncomplicated acute low back pain. Not only does this imaging not improve the outcome, but it exposes the person to unnecessary radiation, delays their care while waiting for results, and costs the individual, the employer and the health system enormous sums. Best-practice guidelines also demonstrate that bed rest is not beneficial and is possibly harmful, and that the person should resume normal activity within a few days.
The paradox of back pain is that even if it goes away on its own, doing nothing about it also leads to poorer outcomes. Acute conditions may become chronic. Most acute back pain is mechanical: caused by overuse, poor posture, excessive weight, arthritis, minor injuries or all of the above. Without a good understanding of why and how it hurts in the first place, we tend to continue to do the same things over and over, reinjuring it until it once again stops us in our tracks. Getting an appropriate diagnosis and starting treatment right away gives the highest likelihood of preventing a recurrence.
The Institute of Physical Medicine and Rehabilitation treats all forms of musculoskeletal conditions, including back pain. In 60 years of dealing with backs, we have learned that most acute back pain patients, if treated right away, recover more quickly and better than those who delay being seen. Anyone whose low back pain is not noticeably better after 72 hours of self-care should be seen by a doctor. Treatment generally involves reducing the inflammation and restoring proper function and strength to the back. Exercise is generally the most effective treatment. Even a gentle regimen of prescribed physical activity will build muscle strength, increase flexibility and improve posture. The best clinical outcomes occur when we not only treat the pain, but also educate the person on proper body mechanics and how to self-manage flare ups with appropriate exercise.
Getting in to see a doctor, particularly a specialist, can seem to take forever when you’re in pain. IPMR now offers a Fast Track Back Care program. For acute (i.e. onset of less than seven to 10 days) back pain, patients can be seen within 24 hours, Monday to Friday. They can receive back-to-back visits with a doctor and physical therapist to start treatment right away following “best practice” guidelines.
The benefits are clear because this approach:
- Minimizes lost work hours
- Reduces the cost of unnecessary imaging
- Improves outcomes with conservative (non-surgical) care
- Educates the person on how to avoid re-injury.
Additional information about treatment of acute back injuries, evidence-based care or reducing the risk of musculoskeletal injuries is available by calling (309) 692-8110. iBi
