If you never suffer from low back pain, consider yourself one of the fortunate few. Up to 85% of people living in industrialized countries will experience low back pain at some point in their lives, and 30% will say their backs hurt right now. Back pain is the most common reason for Americans under the age of 45 to limit their activity. It is the second most common reason for visits to the doctor, and the third most common cause of surgery.
There is some good news, though. With or without medical treatment, most people recover from an acute episode in a few days or weeks, and about 90% will be pain-free within three months. But for many people, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.
Many factors contribute to low back pain—inadequate fitness, heavy lifting, poor posture. But our evolutionary history is to blame for our susceptibility to this pain. At some point in the distant past, some of our ancestors decided to stand on two feet, presumably so their hands would be free to fashion tools and use them efficiently. While their reasons were good, going vertical was not without its drawbacks.
Walking around on all fours distributes the force of gravity evenly over the length of the spine. Standing up, however, concentrates this force in one location—the lumbosacral region, just north of the buttocks. Our vulnerability to low back pain is the price we pay for bipedal locomotion.
Several factors can contribute to persistent back pain:
Most cases of chronic back pain are idiopathic, meaning they have no clear explanation. Without a known cause, treatment is very difficult and often unsuccessful. This leads many people to alternative therapies. Below are among the most commonly used therapies to treat chronic low back pain:
There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of them is superior to the other or to physical therapy, the standard conventional treatment; furthermore, it is not clear that any of these approaches provide more than short-term benefit.
So what then is the best treatment for chronic low back pain?
According to evidence, what seems to matter is not which one, but how many treatments you use. In other words, interventions that address not only the physical aspects of the pain, but also its psychological, social, and occupational influences, were the most effective. Biopsychosocial rehabilitation programs include the following:
This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy, therefore, should be part of a multidimensional treatment strategy.
Some people are skeptical of this comprehensive approach. Although review noted above found positive results, other studies have failed to find that even the most complex and expensive treatments make a great deal of difference. Chronic back pain is simply a difficult problem, and one that current medical techniques do not address with great success.
If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:
RESOURCES:
American Academy of Physical Medicine and Rehabilitation
http://www.aapmr.org/
American Society of Exercise Physiologists
http://www.asep.org/
CANADIAN RESOURCES:
Canadian Society of Exercise Physiology
http://www.csep.ca/
Health Canada
http://www.hc-sc.gc.ca/index-eng.php/
References
Slipman CW, Derby R, Simeone FA, Mayer TG. Interventional Spine: An Algorithmic Approach . Philadelphia: Saunders Elsevier; 2008.
Last reviewed January 2008 by John C. Keel, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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