Oh, My Aching Back

Back pain may be common, but that doesn't make it any less bothersome. Find out how to deal with it -- or prevent it in the first place.

It's in Your Head

Back pain affects nearly half of all adults in any given year and at least two-thirds at some point in their lives. It's so prevalent that in the United States, back pain is second only to upper respiratory infections as the reason people visit their doctors.

Unfortunately, many doctors don't have a clue about what causes back pain, so they order tests, which lead to unnecessary surgery for many people. But back pain usually doesn't signal a serious illness or condition, and in most cases, the pain will eventually go away with minimal treatment. Next time you feel the twinge of backache, here's what you need to know and do.

Why It Hurts
The mystery of back pain starts in your head, says Dennis C. Turk, Ph.D., a pain researcher at the University of Washington in Seattle. "Pain doesn't originate in the body but in the brain," he explains. "Let's say you strain your back. That information is transferred along nerve pathways to your brain, where it's interpreted as pain." And each person perceives that pain differently.

Brain chemistry seems to play a role in pain perception. Recent research at Upstate Medical University in Syracuse, N.Y., found that chronic back pain triggered changes in several brain chemicals, most notably one involved in brain cell communication. According to principal investigator Igor D. Grachev, M.D., Ph.D., a neuroscientist, a reduction in this chemical resulted in increased feelings of pain. "This could explain why someone may feel intense pain when an MRI of the spine shows only a minor problem," he says.

Low back pain can have many causes. It could be a pulled or strained muscle or ligament. It might be a herniated disk, which happens when tears in the outer part of a spinal disk release the jellylike substance that cushions the vertebra above and the one below. The cause might also be arthritis, osteoporosis, an infection of the spine, or physical trauma from a car accident or serious fall. Still another possibility is spinal stenosis, a condition in which bony overgrowths of the vertebrae narrow the spinal canal and hit nerve roots, notes Andrew J. Haig, M.D., director of the Spine Program at the University of Michigan in Ann Arbor. This condition is particularly common in people over 60.

If you have pain, sometimes accompanied by numbness or tingling that radiates down the back of your leg and below the knee, the problem may be sciatica. "Sciatica is usually caused by a herniated disk pressing on nerve roots," Haig says, "but occasionally, it's the result of spinal stenosis."

Although the potential causes are many, about 85 percent of the time no reason for the pain is ever found, Haig says. At best, diagnosis is often a guessing game. Some tantalizing new research, however, points to a genetic component in a small percentage of cases.

To try to figure out what's going on, doctors may order X-rays, MRIs, or CT scans. But all too frequently these tests either don't pinpoint the cause of the pain or they find other back conditions that aren't related to the pain.

"Studies have shown that an MRI or CT scan will show some 'problem' such as a herniated disk or spinal stenosis in one out of three people with absolutely no symptoms of back pain," Turk says. And when a test does show a spinal abnormality in someone with back pain, there's no guarantee that it's the cause of the pain.

Too Many Tests
"There's a tremendous problem with over-testing in this country," says John D. Loeser, M.D., a neurosurgeon at the University of Washington. Unfortunately, that over-testing may lead to unnecessary surgery. This is especially true for older people because of a misperception of what's "normal."

"Radiologists tend to believe that 'normal' equals a picture of an 18-year-old's spine," he points out. "They label age-related changes that occur in almost everyone over 65 as 'abnormal.'"

Does that mean testing is never called for? Of course not. Getting a picture of the spine is necessary for diagnosing low back pain in a person who has a history of cancer, a fever (which could indicate a spinal infection), or has undergone severe physical trauma. For others with low back pain, testing may be advisable if the pain fails to improve after four to six weeks of conservative treatment.

Saying No to the Knife
Surgeons perform approximately half a million back operations in the United States each year. Yet some experts suggest that an astonishing 95 to 98 percent of people with back pain do not require surgery.

When is surgery appropriate? If people have failed to get better after a reasonable period of time or if they have sciatica, they should consider an operation, Loeser says. "But even in these instances, surgery may not be the best choice," he adds. "If you leave disk disease alone, most people will get better with nothing more than physical therapy and other conservative treatment. The problem is that if there's a lot of pain, some people simply can't or won't endure it. A surgical procedure can reduce the pain quickly."

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My mother and my wife—both nurses—were shopping together when a woman in a nearby dressing room fell unconscious. Mom discovered that the woman wasn't breathing, so she and my wife started CPR and revived the shopper just as paramedics arrived.They loaded the woman onto a gurney and were rolling her out of the store when she yelled, "Stop!" My mother and my wife thought maybe she wanted to thank them, but instead she said, "I still want to buy those dresses."

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