5 Dirty Secrets About Back Pain - Revealed

Here's what nobody tells you about back pain.

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Does it seem like every adult you know has back pain? It’s not unique to your circle of friends. Back pain is one of the most common complaints people bring up with their doctors.

Around 80% of adults get back pain at some point. For 16 million adults, that pain is chronic, meaning it lasts three months or longer.

No wonder the back-pain industry has surged, dangling promises of relief to people desperate for it. But relief – especially for chronic pain – can be hard to find.

Back pain secretsBack pain misinformation and misconceptions abound. Here's what nobody tells you.

“There is no magic bullet for chronic low back pain,” says Steven Richeimer, MD, Chief of the Division of Pain Medicine at the University of Southern California’s Keck School of Medicine. “Often, it is best to pursue a rehabilitation approach under the guidance of your doctor. Typically, this includes physical therapy, pain psychology, and occupational therapy.”

Outside of these strategies, most back pain treatments won’t help much – if at all. Some can cause even more problems. Here’s the truth behind five dirty secrets about back pain.

1) Most back pain will get better on its own.

When you have acute back pain (pain that lasts up to four weeks), you don’t need a major intervention. In fact, you may not need to do anything. Most of the time, acute pain – from ordinary muscle strains to more serious injuries – will get better on its own.

“Almost all back pain short of fracture, tumors, or infection will get better with time,” says Reginald Knight, MD, Director of Bassett Spine Care Institute in Cooperstown, NY. “Even if a patient has a herniated disc and pain down the leg, the pain will eventually improve on its own. This means a patient can choose to extend nonoperative care instead of opting for surgery right away.”

There's no way to know for sure how long your back pain will last, but your doctor can give you a general timeframe based on their knowledge and experience.

2) Surgery might not end your pain.

Up to 40% of people still have pain after back surgery. This is called failed back surgery syndrome (FBBS), and there are many possible reasons it.

Failed back surgery syndromeFailed back surgery syndrome is when surgery fails to relieve your back pain, and can actually make it worse.

Back surgery often alters the spine’s biomechanics. Spinal fusion, for example, puts additional stress elsewhere on the spine, which can cause new back problems.

Misdiagnosis is another common reason for post-op pain. You may get surgery for one back issue, when a separate problem is the root of your pain. This type of diagnostic error accounts for as many as 58% of FBBS cases.

3) Opioids won’t help and may hurt.

Say over-the-counter treatments aren’t doing enough for your back pain. You wonder, is an opioid the next step for back pain relief?

Probably not, and for good reason. Research in the medical journal BMJ shows that opioids don’t improve function in people with acute back pain. Opioids for chronic pain may be even less helpful.

“There is growing evidence that while opioids may provide brief relief, at the same time they prolong and worsen chronic pain,” Richeimer says. “I tell my patients that using opioids is like driving down the highway with one foot on the gas and the other foot on the brake.”

Opioids have other downsides, too. In addition to the well-known risk of addiction, side effects include constipation, nausea, sleepiness, increased risk of falls, and with longer-term use, an increased risk of depression and sexual dysfunction.

4) Injections usually don’t help in the long run.

If you have severe low-back pain, your doctor could suggest an epidural steroid injection. The steroid, a powerful anti-inflammatory drug, is injected into your spinal canal. Sometimes it offers major relief. However, it’s a relatively expensive solution, relief may depend on what’s causing your pain, and results don’t usually last.

If your doctor suggests an epidural for pain relief, you may want to ask if the shot has been shown to work for the condition to have. For instance, epidural injections may work well for pain that occurs with a herniated disc – less so if the pain results from spinal stenosis.

5) You might be the reason physical therapy “didn’t work.”

A study in the Annals of Internal Medicine compared outcomes of physical therapy (PT) and spinal decompression surgery in people with low back pain caused by spinal stenosis (narrowing of the spinal canal). These approaches yielded similar results – but PT has far fewer risks.

Other studies have shown similar success with PT for back pain. Yet many people say it didn’t work for them. Why the disconnect?

Physical therapy for back painStudies suggest physical therapy for back pain is effective, yet many patients report it doesn't help. What gives?

Knight suggests the problem could be with the patient or the therapist. “It’s common that patients don’t complete the course of therapy, often because their expectations [weren’t reasonable],” Knight says. “It’s not going to make you better after the first visit. It’s meant to get you started. If you only go once or twice a week, and you’re not doing anything about it at home, you’re not going to get relief.”

But what if you did everything right and still didn’t feel better? That happens, too. In that case, Knight says, “you should talk to your physician, who can tell you if what the therapist is doing is appropriate for your condition.”

Troubled by back pain? Find a spine specialist who can help.

Updated on: 03/30/20
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