When she doesn’t make the hour drive to Medford, Edwards practices what she’s learned at home.
“I do my stretches, train with exercise bands, and apply ice or heat the moment I feel a twinge before it gets really bad,” she said. She also does self-massage using foam rollers and makes a point to take daily walks around her neighborhood. “I realize I’ll have to do this for the rest of my life,” she said.
New England Baptist Hospital’s “back boot camp” offers a program that ranges from a few sessions up to a month. It is geared more toward those with milder back pain who are highly motivated to increase their fitness and join a gym after the program. Both programs are covered by insurance, but patients have to meet co-payments ranging from $15 to $40 for each visit.
“We talk a lot about self-efficacy,” said Dr. Carol Hartigan, a physiatrist at the hospital who designs tailored rehabilitation plans for back patients. “People can become very fearful of moving when their back hurts, but we give them permission to use their bodies.”
Patients are initially evaluated to see how fast they can walk, how far they can stretch, and how much they can lift with their back muscles using a weight machine, to set clear fitness goals. Studies performed by Hartigan and others suggest that the program leads to less pain and improved function that lasts for up to two years.
“A big part of the response is felt to be related to the education component,” said Hartigan, “that pain is safe, that hurt does not equal harm, and that moving normally and exercising in the setting of pain is safe and advisable.”
Still, some patients may find that despite their best efforts, they are left with unremitting agony that requires surgery for some level of relief.
After nearly completing the Spaulding program, Sean Sullivan, 44, a Medford resident, said he’s thinking about having surgery to fix the pinched spinal nerve that is causing pain to radiate down his leg.
“I’ve been trying to avoid surgery,” he said. “But it helped me back in 1997 before my back got worse again a few years later.”
Surgery won’t cure back pain even in those with clearly defined mechanical problems: a ruptured disk, scoliosis, or spinal stenosis, which causes a pinched nerve due to a narrowing of the nerve canal from arthritis.
“I can’t make anyone’s back 18 years old again with surgery,” said Dr. Frederick Mansfield, an orthopedic spine surgeon at Massachusetts General Hospital.
He typically suggests surgery if patients have clear anatomical problems that could be causing their pain — though abnormalities that show up on an MRI are not always the pain trigger — and if they’re not getting enough relief from conservative treatments such as painkillers. Only 30 percent of his patients, he said, find that occasional spinal steroid injections work for them long-term.
With surgery, Mansfield added, patients, in the best-case scenario, find that their pain goes from an 8 or 9 — with 10 being intolerable — down to a 3, and that the benefits last for several years. Some have more modest declines in pain or find that their pain returns after just a year or two.
Others experience no improvement from surgery.
“About 85 percent of my patients with spinal stenosis are satisfied with the results,” Mansfield said, “but the rest experience no decline in their pain or, in a small percentage of cases, may have more pain if they develop an infection or scar tissue, which can be completely unpredictable.”
Minimally invasive spine surgeries — which involve an inch-long incision and are performed through an endoscope — have been growing in popularity. They reduce hospital stays from several days to one or two and reduce recuperation time from six weeks down to two or three, according to Mansfield. A 2011 study published in the journal Spine that examined data from more than 100,000 surgery patients found that the minimally invasive technique was associated with fewer post-operative infections compared with open procedures with much larger incisions. There’s not enough evidence yet, however, to conclude that the technique offers better pain reduction or longer-lasting results.
Deborah Kotz can be reached at email@example.com.