Relief for aching backs
Hands-on therapies were top-rated by 14,000 consumers
About 80 percent of U.S. adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half said pain severely limited their daily routine for a week or longer, and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weight.
Back pain can be tough to treat. Most of our respondents tried five or six different treatments. They rated the helpfulness of the treatments tried and their satisfaction with the health-care professionals visited.
Hands-on therapies were among the top-rated. Fifty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were “completely” or “very” satisfied with their chiropractor. Massage and physical therapy were close runners-up.
Many of those who tried spinal injections found them to be very helpful, although the techniques their doctors used varied. Most respondents had used some type of medication. Forty-five percent of those who took prescription drugs said they helped a lot, double the percentage of those who said they were helped by over-the-counter medications.
Where to go for treatment
“Everyone seems to be selling some kind of gimmick, treatment, or pill for low-back pain,” says neurologist Scott Haldeman, M.D., who co-edited the January/February 2008 issue of The Spine Journal, which reviewed ways of treating low-back pain. But when treatments abound, it’s usually because there’s no clear winner.
A visit to a primary-care doctor is a smart first step when back pain is severe. A doctor can help rule out disease, such as infection or cancer. Although many of our respondents who saw a primary-care doctor left dissatisfied, doctors can write referrals for hands-on treatments that might be covered by health insurance.
Enduring the pain or seeing a chiropractor or physical therapist as a first step might be OK for a recurrent, familiar back problem. Most of the 35 percent of our respondents who didn’t see a health professional had severely limiting pain for less than a week. Many of those with more prolonged pain who didn’t see a healthcare professional said it was because of cost concerns or because they did not believe professional care could help.
Research suggests that chiropractic manipulation can reduce acute low-back pain, and many, though certainly not all, of the respondents who tried it said it helped. Albert McCann, 54, a respondent from Lakeland, Fla., has kept working as a petroleum transport engineer, driving a semi truck and using 20-foot-long hoses several times a day. By following a chiropractor’s recommendations and getting treatment every few weeks—including manual adjustments, electric stimulation, and a spinalator (roller-massage table)—he is able to keep his back pain to a minimum.
Massage and physical therapy were other treatments rated very helpful by 48 and 46 percent of consumers, respectively. “My back pain was unrelenting,” says survey respondent Charlene Mower of Fayetteville, Ark. “Before physical therapy, I thought I was done for.” Mower, 51, hurt her back while trying to lift her bedridden mother. She credits the training in lifting and bending techniques that a therapist gave her and continued exercise for her long-term success in staving off pain.
Lifestyle changes can help .
Cindy Pickett developed low-back pain at age 22, when she was building a bookcase and suffered two slipped disks. Over the years back pain and other factors led to a 100-pound weight gain. At 59, Pickett, a schoolteacher from Flagstaff, Ariz., retired and decided to make weight loss and exercise her full-time job. She credits her improvement to the combination of weight loss and abdominal-strengthening exercises that reduced pressure on her lower back. Pickett reports that she has not had to take pain relievers for months.
Forty-four percent of our survey respondents found exercise helpful, making it the top self-help measure. And a surprising 58 percent of respondents wished that they had done more exercises to strengthen their backs in the past year. That is more than twice the number who told us they wished that they had reduced or avoided activities that might make the pain worse.
Use caution with surgery
Your doctor might suggest you see a surgeon if back pain is unrelenting and no other treatment seems to work. We conducted a separate survey of almost 1,000 consumers who have had back surgery in the past five years.
Those who had back surgery had tried nine to 10 treatments and described themselves as much more impaired by their pain than people with back problems who did not have surgery. Just 60 percent of the back-surgery respondents were completely or very satisfied with the results, compared with 82 percent of respondents who were satisfied after hip- or knee-replacement surgery in our 2006 survey.
But satisfaction depended on the diagnosis and the type of surgery. Those with degenerative disk disease (arthritis of the spine) were far less likely to be highly satisfied with surgery (54 percent) than those with a herniated disk (73 percent) or spinal stenosis (71 percent).
Alfonso Sanchez, 38, a state senatorial aide from Sacramento, Calif., was highly satisfied with his lumbar discectomy. His back pain turned excruciating when he was canvassing door-to-door in the hills of San Francisco last June. After failing to improve with acupuncture, physical therapy, and chiropractic treatments, Sanchez underwent a microdiscectomy last August. Remarkably, as soon as he woke up from the anesthesia, his pain was gone. He is now back to gardening and riding a bike to work.
But not everyone does so well. More than 50 percent of respondents reported at least one problem with recovery, finding it lengthier and more painful than they had expected. Indeed, 16 percent of back-surgery respondents said that their back pain did not improve, and half of those said it became worse after surgery. The most common regret was that more post-surgery rehabilitation was not planned.
If you’re told you need surgery, get a second opinion from another practitioner, preferably one who is not a surgeon. If you decide that surgery is the best approach, ask whether the surgeon is board-certified and find out how many operations he or she has done.
For more guidance, see our free diagnostic tool for back pain at www.ConsumerReportsHealth.org. More detailed information is available to subscribers to that site, including consumer ratings and the medical evidence for 23 back remedies
Who helped the most?
The percent of people highly (completely or very) satisfied with their back-pain treatments and advice varied by practitioner visited.
Professional – Highly satisfied
Physical therapist 55%
Physician, specialist 44%
Physician, primary care 34%
Differences in Ratings for physical therapists and acupuncturists were not statistically significant.
Article is from “Contents: Consumer Reports” Magazine
May 2009 pages 12-13