Back Pain
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person, it may do nothing for another.
Neurologists speculate that this may
be due in part to the way pain signals
travel up the spine to the brain. It also
may be because most people who see a
doctor for low back pain actually have
several things wrong with their back.
(In my case, an X-ray showed how a
slight case of scoliosis was aggravating
degenerating discs and bone spurs that
were developing.) “At this point we have
no way to test for—or treat—multiple
back problems in isolation, so we have
to resort to hit or miss,” Rao explains.
That said, emerging research suggests we’re getting closer to discovering
what works best. A review in the February 2009 Journal of the American Academy of Orthopaedic Surgeons concluded
that physical therapy combined with
nonsteroidal anti-inflammatory drugs
(such as ibuprofen or naproxen) is the
most effective treatment for degenerating discs. According to the American
Association of Neurological Surgeons,
90 percent of herniated discs can be
effectively treated with conservative
therapies such as limited bed rest,
exercise, and anti-inflammatory medications. This would be heartening but
for a study in the February Arthritis
Care & Research, which found that fewer than half the participants who saw a
health professional for back pain in the
past year had been prescribed exercise.
I personally made some ground-breaking discoveries about physical
therapy not long after becoming ambulatory again: staying healthy can
be hard work, and it doesn’t always
feel so great. “You may feel some pain
when you start physical therapy, even
if it’s just walking,” says Carey. “This
is normal.” If the exercise consistently
causes greater pain than the initial pain
in your back, stop doing it and check
with your physical therapist. But if the
pain seems to lessen with each workout, you’re on the right track.
If physical therapy isn’t doing the
trick, it’s time to try other approaches,
says Jack Stern, M.D., Ph.D., a neuro-
surgeon and senior member of Brain
and Spine Surgeons of New York, in
White Plains. Here are a few of the
most commonly prescribed therapies
for chronic low back pain—and the
potential benefits of each.
; Chiropractic To clarify a common
misunderstanding: chiropractors don’t
“crack your back.” That popping sound
is a gas bubble being released from be-
tween two joints that have been coaxed
into alignment. A study published in
2002 found that patients with low back
pain treated by chiropractors showed
greater improvement after one month
than those treated by physicians.
; Acupuncture The needles used in
acupuncture may work by stimulating
the nerve fibers that transmit signals
to the spinal cord and brain, which then
release hormones that make us feel
less pain.
; Medication NSAIDs, including ibu-
profen (Advil) and naproxen (Aleve),
help reduce swelling and inflamma-
tion. COX- 2 inhibitors such as celecoxib
(Celebrex) are a type of NSAID with
fewer gastrointestinal side effects.
Analgesics such as acetaminophen
(Tylenol, Anacin Aspirin Free) are
used to treat acute pain, as well as some
forms of chronic pain. Opioids such as
morphine and codeine can be habit
forming, so they’re usually prescribed
only if pain is severe. Muscle relaxants
such as cyclobenzaprine (Flexeril),
diazepam (Valium), and carisoprodol
(Soma) also are often prescribed for
severe muscle spasm.
