Approaches to Ease Lower Back Pain

About 4 out of 5 people will fall victim at least once in their lives to the relentless dull aches, the searing flames, and the stabbing throbs of lower back pain. However, while back pain is usually no more life threatening than the common cold, it can be as debilitating as a heart attack. It is the leading cause of lost workdays among people younger than 45 and the reason $50 billion a year is spent on diagnosis and treatment. There is little doubt that as sedentary habits, poor computer posture, and the aging process catch up with baby boomers, the problem will only get worse.

Now, though, researchers are learning enough to debunk some conventional wisdom–for example, that heavy lifting is to blame and that resting a painful back is a good idea–and to identify ways to ease pain, hasten healing, and lessen future problems. Much of the advice from pain doctors focuses on getting moving despite back pain–walking around at work, exercising as much as possible, and even using the back to help it to heal.

The Amazing Back

The spine consists of 33 vertebrae resting atop one another, cushioned by shock-absorbing disks, tied together by countless ligaments and dozens of muscles. And the spinal cord runs right through a hollow column in the middle of it all, sending nerves out to the body through gaps between each vertebra. When any one component of the system goes awry, it throws others out of whack as well –one reason why a minor problem like a bruised muscle can put the whole back in agony.

No wonder there's such confusion about the causes and cures of back maladies. A full 85 percent of people who seek help for back pain, studies show, never get a definitive diagnosis, because it can be traced to problems as varied as ruptured spinal disks, muscle spasms, tendon tears, and bone degeneration. Victims are similarly perplexed by the growing array of touted cures. Entire shelves in bookstores are devoted to the latest in back pain wisdom, which ranges wildly from surgery to chiropractic and from physical therapy to acupuncture.

With so many different working parts–and a medical specialty devoted to each one–many patients go from place to place without ever getting the same opinion twice.

Sitting and stress

The back works so hard through just about every life activity that it can seem impossible to know whether to blame damage on poor posture, stress, "couch potato" habits, weekend athlete syndrome, or something else entirely. But research offers at least a clue, and the worst culprit is modern life. Sitting too much, for instance, leads to far more lower back pain than does heavy lifting. Some research finds especially high rates of back pain among truckers and others who drive for a living, and epidemiological studies show that as office work has replaced heavy labor, more people have complained about their backs. Further research supports the intuitive idea that stress can lead to back pain. One study finds that patients who do not show physical signs of injury are more likely to report high levels of stress than back sufferers with a glaring physical problem.

Back pain linked to stressful events.

For decades, doctors have sent patients with back pain to bed with strict orders to stay there for at least a week. Early logic had it that, just like a broken bone, an injured back should not be used until it has healed. But now, doctors say the key to the fastest recovery is to stay out of bed as much as possible. That's because little-used muscles and other tissues weaken so quickly that just a few days of inactivity can be harmful. One study led by Deyo found that it was not the severity or duration of patients' pain that predicted how much work they would miss; it was a doctor's advice to stay in bed.

In fact, the more scientists study exercise, the more powerfully they prescribe it. A combination of stretching, strengthening, and aerobic exercises probably does the most good for back pain, for a myriad of reasons. Active muscles rebuild themselves more quickly, and because spinal disks don't contain blood vessels, they rely on the body's movement to bring healing nutrients their way. Exercise also sends natural painkillers flowing through the body. Perhaps that is why recent studies suggest that as athletic activity increases, so does the threshold for pain.

The power of motion

As strongly as researchers encourage getting moving, this can be difficult advice to follow. A key in using exercise to hasten back pain relief, says H. Rand Scott, M.D, is to distinguish hurt from harm. The pain could get worse while a back sufferer exercises, but that does not mean the activity is dangerous. One way to exercise is to break tasks down into small, more frequent activities with brief rests in between. That way, at the end of the day, the total activity level is very good.

Exercise also helps by controlling weight, which plays a role in protecting the back from pain. The body's center of gravity is in front of the spine, and there is a natural tendency for everyone's back to be pulled too far forward–one of nature's inherent design flaws. Each pound gained adds to that forward pull; each pound lost eases it. Losing just five or 10 pounds, can help frequent back pain sufferers feel much better.

Relaxation techniques such as massage, yoga, and meditation probably do some good for back pain, for at least two reasons. First, say researchers, people in a state of stress hold their muscles in a tightened position, which reduces blood flow, cuts off oxygen and builds up painful waste products, and can lock muscles in a constricted spasm. Second, many people can remain unaware of their body position or pains for hours as they concentrate during the workday; relaxation courses can teach them to heed signals from their body before too much damage is done.

Last resort

For most lower back pain sufferers, surgery is not even an option. Still, the number of procedures exceeds 600,000 a year. Some of the most common surgeries remove a piece of bone or spinal disk to ease pressure on troubled nerves. Despite horror stories about one surgery leading to another and even making things worse, studies generally show good outcomes for most procedures. Further, less-invasive techniques are being developed to minimize risks such as infection.

Pain can stay when the problem is gone

For up to 15 percent of sufferers, low back pain becomes chronic, causing constant, debilitating pain. Pain's intensity is determined not just by an actual injury but also by the interaction of many chemicals that send messages to and from the brain. Pain can linger long after the initial problem is solved. After a while, pain can perpetuate more pain, independent of what first caused it.

Pain may be heavily influenced by a mix of genetic, physiological, and chemical factors. Researchers have found that some people have more pain-producing chemicals, such as a neurotransmitter known as substance P, and fewer pain-relieving chemicals, such as serotonin and adrenaline, in their nervous systems. In some studies, men and women respond differently to the same painkilling substance. And significant differences in reaction to pain are being found among different strains of lab animals. While stepping on something too hot can leave one strain of rats limping for days, another strain shows virtually no signs that anything painful has happened.

Genetic research, now in its infancy, may one day help prevent severe back pain. A much-celebrated study published in Science identified a mutant gene that may underlie some cases of sciatica, an especially painful problem caused when a spinal disk herniates and its leaking jellylike center damages the sciatic nerve.

If you have back pain, see a pain management specialist. There are many new advances pain doctors use to help you recover from this debilitating problem. For more information go to

Reference:

Joannie Schrof Fischer US News & World Report