Back pain: the latest guidelines

In the space of three days, a woman told me her father had committed suicide because of back pain; I visited a friend recuperating from an eight-hour spine surgery; I had lunch with a friend who could barely sit through our meal because of the pain from botched back surgery 20 years ago. At about the same time, the American College of Physicians published guidelines for lower back pain that says, essentially, to stay active, wait it out, and believe it can get better. They add that if the pain lasts for less than four weeks and does not radiate down the leg, there’s no need to see a doctor. They also say that scans, such as MRIs for diagnosis are useless because results are misleading.

Naturally, I subscribe to these new guidelines. On the other hand, I’ve never had serious back pain—which makes it easy for me to agree. If, like my friend recovering from surgery, the pain had lasted for years, ran down the leg, and showed serious vertebra displacement, I might opt for surgery also. This vertebra doesn’t look like it will fix itself! Another friend who has had three fusions over the course of 15 years reports complete success. But another reports nerve damage and lingering pain as a result of surgery.

The new guidelines are a response to the epidemic of opioid use and the recommendations are aimed at discouraging doctors from prescribing painkillers—even over-the-counter painkillers. Readers of the guidelines, as reported in The New York Times, had plenty to say in their online comments. They seemed to be evenly divided between those who were incensed at the idea of curtailing their pain medications and those who provided advice to the pain sufferers. Examples of the former group: “I need opiates and muscle relaxers in order to function;” “Walk a mile in my shoes or in my case pajamas.” The advice offered by the latter group included ice, stretching, probiotics, drinking a lot of water, marijuana, low acid diet, divorce and, my favorite, chewing your food 40 times. None reported surgery as having eliminated their pain.

In tallying the successes and failures of spine surgeries among my friends, I would lean towards waiting it out. But then, I've never walked a mile in a sufferer's pajamas.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.