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2017 — Science update: Updated references for debunking of TENS for back pain. Added ultrasound to the section. [Section: A few more snack-sized reality checks: brief comments on other treatments to avoid.]

“Scientific studies now indicate prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work.

Is “much” information really “just plain wrong”? I will establish this in the sections ahead with a steady supply of clearly explained references to the medical literature that patients can understand and professionals can respect. This extra layer of information in easy-to-use footnotes is available for any reader who wants to dig deeper and check my facts. example, here’s a good start: In 2010, the Journal of Bone & Joint Surgery reported that “the quality and content of health information on the internet is highly variable for common sports medicine topics,” such as knee pain and low back pain — a bit of an understatement, really. Expert reviewers examined about 75 top-ranked commercial websites and another 30 academic sites. They gave each a quality score on a scale of 100. The average score? Barely over 50! For more detail, see Starman et al. BACK TO TEXT

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Most commonly, mechanical issues and soft-tissue injuries are the cause of low back pain. These injuries can include damage to the intervertebral discs, compression of nerve roots, and improper movement of the spinal joints.

Berman BM, Langevin HH, Witt CM, Dubner R. Acupuncture for Chronic Low Back Pain. N Engl J Med. 2010 Jul 29;(363):454–461. PubMed #20818865. PainSci #54942. ← That symbol means a link will open in a new window. Try one!

Mental health factors: Pre-existing mental health issues such as anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.

Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), might relieve acute back pain. Take these medications as directed by your doctor, because overuse can cause serious side effects.

The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called “Disability Adjusted Life Years.” DALYs, as they’re abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn’t spend living your #bestlife—because you were sick or dead.

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When comparing VAS scores between the lumbar support and standard chair conditions, a difference was seen only in the neck region in the LBP group (p = 0.045). The VAS was lower with the lumbar support than with the standard chair. However, due to the potential inflation of Type I error (falsely concluding a significant effect) due to the testing being done at seven different sites for each group, when proper adjustment is made for multiple testing using Holm’s method, the neck region does not achieve statistical significance. The unadjusted means and standard deviations for the VAS scores for level of discomfort are summarized in Tables 3 and ​and44.

Opioid painkillers like OxyContin, which are also commonly prescribed for back pain relief, also have a highly addictive nature. In fact, opioids are among the most commonly abused prescription drugs today, and are a leading contributor to the increasing rates of fatal prescription drug overdoses. This is why back pain is now one of the primary reasons why so many American adults get addicted to painkillers.

2009 — New section: Today I found a way to say some simple things about the power of self-treatment that have been “on the tip of my tongue” for years now. It all evolved from writing about an important bit of research, showing that manual therapists cannot (reliably) diagnose trigger points. [Section: Limitations of trigger point therapy, and how to take advantage of them.]

Injections. If other measures don’t relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — or numbing medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

Meanwhile, it’s extremely common for non-life-threatening low back pain to be alarmingly severe and persistent — to have a loud bark! Your doctor may not appreciate how true this is, and may over-react to all persistent low back pain, even without other red flags. In most cases, you shouldn’t let them scare you. Being “freaked out” about persistent back pain is the real threat: it can make low back pain much worse, and much more likely to last even longer (a tragic irony).

2016 — Science update: Some fresh citations that strongly reinforce the main point of the section, and a few entertaining new examples of weird placebo effects. [Section: The back surgery placebo problem, and how it limits our knowledge of the effectiveness of back surgeries.]

Spinal stenosis : If you have this, your spinal canal has narrowed. That adds pressure on your spine and nerves. As a result, your legs and shoulders probably feel numb. This happens to many people older than 60.

Spinal manipulation: Osteopathic or chiropractic manipulation appears to be beneficial in people during the first month of symptoms. Studies on this topic have produced conflicting results. The use of manipulation for people with chronic back pain has been studied as well, also with conflicting results. The effectiveness of this treatment remains unknown. Manipulation has not been found to benefit people with nerve root problems.

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