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More on Dealing With Back Pain
- 5 Causes of Back Pain
- New Thinking on How to Relieve Back Pain
- How to Recover From a Back Injury
- Back Stretches and Strategies to Keep Away Pain
- Home Remedies for Back Pain: What Really Works
- Does Insurance Cover Acupuncture & Other Nondrug Therapies?
- The Link Between Chronic Pain and Depression
- Guide to Treating Back Pain
Why Your Back Hurts
Medical experts surmise that back pain has bedeviled humans ever since we started walking on two feet, says Richard Deyo, M.D., a professor of evidence-based medicine at Oregon Health and Science University and an author of the main scientific review that led to the new ACP guidelines.
Standing upright requires the spine to support the weight of the upper body while still being flexible enough to bend in many directions. That puts a lot of stress on the back’s complex network of bones, muscles, and ligaments. For example, muscles and ligaments can be overstretched, the gel-like disks cushioning the spinal bones can bulge, and the disks can slip, pressing painfully on spinal nerves.
Sometimes, all it takes to trigger a malfunction is lifting something heavy, twisting awkwardly, or simply sitting too long with poor posture. (See “5 Causes of Back Pain.”)
Aging can make the situation worse because disks wear and shrink. Add to that diminished strength and flexibility, and you have the perfect conditions for pain.
Too Many Tests and Treatments?
When a back attack strikes, often the first reaction is to run to a doctor for an X-ray or MRI to see what’s causing so much pain and possibly to ask for a prescription.
Doctors increasingly have an inclination to order more tests and write more prescriptions. A 2013 study in the Journal of the American Medical Association found that between 1999 and 2010, the prescribing of powerful narcotic pain meds increased by 51 percent, the use of CT and MRI scans jumped by 57 percent, and referrals to surgeons, neurologists, and other specialists more than doubled.
These kinds of escalating interventions are still the hallmark of how back pain is usually treated in the U.S., Deyo says. But those conventional approaches don’t always work and can cause other serious problems.
“Overall, we’ve seen no reduction in either pain or disability,” Deyo says. “And at the same time, rates of serious complications and even death are rising due to overuse of invasive treatments and opioids.”
Conventional treatment often fails because “it focuses on individual symptoms and broken parts,” says Donald Levy, M.D., medical director of the Osher Clinical Center for Integrative Medicine at Brigham and Women’s Hospital in Chestnut Hill, Mass.
Instead, he says, doctors “should be thinking about treating the whole patient—helping people get stronger, which will not only speed recovery but also help prevent future episodes of pain.” (For advice on how to do that, see “New Thinking On How to Relieve Back Pain.”)
Here’s how overusing common back-pain tests and treatments can make the discomfort worse, not better:
The Trouble With Imaging
A vast majority—82 percent—of our survey respondents who saw at least one healthcare professional for back pain said they got an X-ray, a CT scan, or an MRI. But most people who develop back pain don’t need those tests.
Why not? Because, Levy says, “the broken parts seen on imaging studies do not always correlate with the source or the degree of pain.”
But when doctors see signs of arthritis or other damage, they often have an urge to fix it, Levy says, “and that can lead to unnecessary surgery.”
It’s not always wise for patients to see those abnormalities, either, because it can undermine their confidence that they can continue to lead healthy, active lives. “All of a sudden, people may think, ‘I’m not someone with a temporary bout of pain, I’m a back-pain patient,'” says Matthew Kowalski, D.C., a chiropractor at the Osher Clinical Center. “And that image can stay with them for the rest of their lives.”
The Risks of Opioids and Surgery
About one-third of our survey respondents said they took prescription drugs for their back pain, and of those, 57 percent were prescribed opioids.
The ACP strongly advises against that practice. For one thing, opioids don’t necessarily relieve pain much better or help you move more easily than over-the-counter anti-inflammatory drugs such as ibuprofen (Advil and generic) or naproxen (Aleve and generic).
And though those OTC drugs pose some risks when taken long term, they’re still much safer than opioids. Narcotic medications often cause side effects such as constipation, drowsiness, headaches, and nausea. The longer you take them, the greater the risk of addiction and overdose, especially when taking high doses.
A recent review in the Journal of the American Medical Association of 20 trials involving nearly 7,300 patients found that opioids didn’t provide significant relief for people with chronic back pain. Further, half the participants dropped out early because the medication didn’t work or the side effects were intolerable.
Surgery should always be the last option, and only if your pain has lasted longer than three months with treatment and your symptoms are severe and clearly linked to the problem seen in an imaging test. But even then, it’s reasonable to hold off on surgery if you’re seeing improvement, Levy says.
For one thing, it can’t cure arthritis, injured or weak muscles, poor posture, or many other common causes of back pain.
Even symptoms caused by a herniated (slipped) disk or spinal stenosis (narrowing of the spinal column) may resolve over time with those simpler, less aggressive therapies. And taking that approach is safer than surgery, which carries rare but serious risks such as infection, blood clots, and damage to the spine.

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