Aspinal injection to treat back pain that is linked to more than two dozen deaths in the recent meningitis outbreak — due to contamination of the drug with a fungus — has focused the spotlight on an oft-used steroid treatment that’s only modestly effective at reducing pain in most patients. This raises the question: Is there a better treatment for the 10 percent of Americans affected by low back pain?
No doubt, spinal injections that block inflammation, over-the-counter and prescription pain relievers, and physical therapy can bring considerable short-term relief, and often back pain heals on its own. But for those with lingering symptoms, back pain cures remain elusive.
“Back pain, unfortunately, isn’t something we’re very good at treating,” said Dr. Steven Atlas, a primary care internist and director of the Primary Care Research & Quality Improvement Network at Massachusetts General Hospital. That’s despite the fact that magnetic resonance imaging scans can precisely pinpoint disk, nerve, and other spine abnormalities, which has led surgeons to perform increasingly complicated procedures to fix several things at once. They’re doing 15 times more complex back surgeries today than a decade ago, according to recent research published in the Journal of the American Medical Association. Doctors have oversold the potential for a lasting cure from any treatment, Atlas said, when they instead should be emphasizing “finding the most effective management for the condition.”
A growing body of research suggests that the best way to manage back pain is to get up and move around, stretch and engage in resistance training to increase flexibility and core body strength, and find ways to psychologically deal with the daily discomfort.
“A lot of patients have to accept the fact that they’re probably going to have back pain off and on for the rest of their lives,” said Ann Webster, a health psychologist at the Benson-Henry Institute for Mind Body Medicine. She teaches patients in 10 weekly group and individual sessions various relaxation techniques. The sessions, which are covered by insurance, help patients to stop tensing muscles when they feel pain, which is an instinct that ultimately leads to more discomfort.
“I teach meditation, guided imagery, and mindfulness to get them to acknowledge the pain without anger,” she said. She also teaches yoga, even to those whose back pain has forced them to use walkers or wheelchairs.
The training program does not necessarily lead to less back pain, but most are not bothered as much by it.
“They change their perspective,” said Webster. “They feel more optimistic because we’ve removed the emotional component associated with the pain.”
Studies measuring the pain-reducing benefits of mental health techniques have yielded mixed results, and exercise programs are “slightly effective at decreasing pain and improving function” compared with no treatment or conservative treatments such as over-the-counter painkillers, according to a 2005 review of 61 clinical trials conducted by the Cochrane Collaboration, a nonprofit research group.
But some specialists contend that the biggest benefits occur when physical therapy, exercise, and relaxation techniques are combined into a single program tailored to the individual patient.
That’s the tack taken by Spaulding Rehabilitation Network in Medford, where patients participate in education seminars, therapy sessions, and exercise classes for several hours, twice a week for six weeks, to learn the basics about caring for their backs. They’re given stretches, strength training moves, and a home workout plan and learn the proper techniques for rising from a chair, lifting grocery bags, and other functional activities.
“We typically get patients who don’t respond to physical therapy or painkillers,” said Dr. Alec Meleger, medical director of the rehabilitation program, “and 87 percent of our patients achieve their functional goals,” which may be to return to work, start playing tennis again, or walk unassisted. While some participants experience a significant reduction in their daily pain, becoming pain-free isn’t the ultimate goal of the program, said Meleger. It’s to get them back to the daily routine they had before the back pain started.
After making twice-weekly visits to Medford for three weeks, Sandra Edwards said she wakes up only once a night from her back discomfort instead of every hour or two. “It’s brought a big change in my quality of life,” said Edwards, 45, from the Worcester area, who suffered low back injuries from two car accidents in the past six years.Continued...