The trouble with back pain
I was busily writing a beseeching piece on the health link between us and bumblebees when a news alert popped up. I dropped everything, and changed course to deliver you the newest on the oldest of health problems – back pain.
For decades, experts have pussyfooted around “pain” using language like “should, would, ought to consider” as they try to be sensible and sensitive, empowering, evidence-based and politically correct. The message was, as Tennessee Williams would have said, “all hawk, an’ no spit.”
The pain business remains murky water.
But weeks ago the American College of Physicians (ACP) published its back pain management guidelines, the first since 2007, using clear, simple terms, much like a determined mother, standing akimbo, reading off last rites to a son who’d broken the 12-o’clock curfew, again.
I can summarize the bare bones in two sentences. And if you can handle what I’m about to say, no need to read any further.
- Back pain doesn’t take days, or weeks to recover – it takes months to years.
- Doctors have no cure.
In an article interviewing Dr. James Weinstein, a back pain specialist from the Dartmouth-Hitchcock Health System, the New York Times had a cracking opening line. Weinstein's “advice for most people with lower back pain: Take two aspirin and don’t call me in the morning.”
Everybody gets back pain: shoveling snow, pulling carpets, picking up friend’s wiggling 10-month-old who’s a lot heavier than she looks, or doing what I did – turning to take paper out of a printer. In any three months, 25 percent of Americans suffers back pain.
With or without intervention, more than half improve within one month. Most improve by three months. Prognosis is good.
Understandably, a lot of people worry about doing things that can make it worse.
The ACP recommends these initial approaches:
- Keep moving. Bedrest, especially for days, may hinder recovery.
- Try “superficial heat, massage, acupuncture, or spinal manipulation.”
- If pain is still limiting, ibuprofen 600mg three times daily or naproxen 500mg twice daily may take the edge off. Or call your doctor for muscle relaxants.
- Steroid (by mouth or injections) and acetaminophen don’t work better than placebo.
By one year about a third have lingering pain, and about three in four can have another bout of back pain.
For chronic back pain, pain lasting more than 3 months, the ACP recommends “exercise … mindfulness-based stress reduction, tai chi, yoga...”
In other words: stay active – call it rehab, physical therapy, yoga, Pilates, running, swimming, it doesn’t matter; just stick with what you can do and enjoy doing – and stay calm.
The perception and experience of pain are physical and psychological. Living with chronic pain, distractions help. Normalcy counts. Isn’t it high time to start eating better, walking more? If it feels like life is a drawn-out Sophie’s Choice, try asking a different question: “Does it really matter?”
Unlike our haphazard, partisan and profit-driven cobwebs of a healthcare system, our body, a 37.2 trillion-cell system, is designed to self-manage expertly with backup Plan A to Z, Platinum, Gold, Silver, and Bronze.
Have ye some faith.