‘Oh, my aching back!’

An aching back  a dull twinge or a stabbing pain, lasting for days or months  is a source of annoyance, misery or even disability for millions of sufferers.  Eighty percent of the population is estimated to experience back pain at some point in their lives, and while the majority of cases resolve quickly, 30 percent recurs.

Those aching backs, in turn, cost the Philippines hundreds of millions in healthcare costs, time off from work and other expenses.  According to the recent Bureau of Labor and Employment Survey, back pain is the top complaint of Pinoy workers, accounting for 35 percent of occupational diseases reported by companies employing at least 20 workers.

There is evidence that the suffering is rising slightly — perhaps because people spend more time hunched over computer keyboards.  A 2008 study published in the Journal of the American Medical Association found that the percentage of US adults seeking medical help for spine problems rose from 12 percent in the year 2000 to 15 percent in 2005.  Rising significantly, meanwhile, are expensive treatments and surgeries that may not help patients much.

“I don’t think you want to take the surgical option lightly,” says Dr. Gunnar Anderson, an orthopedic surgeon at the Rush University Medical Center in Chicago.  For the lucky ones who benefit from surgery, it’s certainly worth the risk and cost, he says.  Others may not get the results they anticipate.

Back structure

The spine is a stack of bony vertebrae separated by gel-filled discs that act as shock absorbers. “It’s one of the major ways the human body fails,” says Dr. Aaron Filler, a spine surgeon in Santa Monica, CA, USA.  In part, back pain is the price mankind pays to stand upright.  When the spine is horizontal, as it is in a four-legged animal, additional weight causes the vertebrae to spread out.  But in people, more weight pushes the vertebrae and discs together — and there is only so far the structure can compress.  Over time, the effects of aging, use, and gravity, wear on the spine, making the 40-plus crowd most susceptible to back pain, though injury or stress can occur at any age.

Back pain is a symptom with many possible causes.  Sprains, muscle tears, and spasms are common.  The discs, which cushion the vertebrae, can also suffer injury.  In a herniated disc, the gel inside leaks out and irritates nearby nerves (see diagram).

The joints between the vertebrae, called facet joints, are susceptible to wear and tear, particularly in people with arthritis.  The joints cushioning cartilage can wear thin and the bone can jut out, causing pain in the back and thighs.  And as the discs or bone protrude past their normal locations, the interior of the spine can narrow, putting pressure on nerves in a condition called stenosis.

Being inactive can contribute to back problems because the body’s core muscles — the back and abdominal muscles that hold up the torso — weaken and become more susceptible to tears or pulls. Weak muscles can also cause problems by forcing the spine to support extra weight — as does obesity.

The good news is that most back pain goes away on its own.  For minor complaints such as muscle strains, most doctors recommend over-the-counter painkillers and heat to relax the muscles.  In addition, it is best to be up with daily activities as much as possible. “Doctors used to recommend bed rest for back pain. It turns out people get worse with bed rest,” Dr. Filler says.  Allowing the muscles to weaken can slow recovery — whereas stretching and physical therapy can hasten it. A 2005 review found that patients who remained active, compared to those on bed rest, had a bit less pain and recovered a little more function.

Signs OF trouble

A primary care physician can evaluate back pain and make sure it doesn’t signal something serious, such as an aneurysm, an ulcer, cancer or an infection.  Numbness, pain that shoots down the leg (“sciatica”), or trouble controlling bowel or bladder may indicate nerve damage and require medical attention.  If the pain is the result of an injury or fall, one should also see a doctor to make sure nothing is broken.

When pain lasts more than three months, doctors classify it as chronic back pain. They will use a detailed history, physical exam and, sometimes, X-rays or other imaging tools to decipher what’s wrong.

Treatments

There are several possible treatments for back pain.  If a disc is damaged, a surgeon can remove the leaking or bulging material, or take out the disc entirely.  For a fracture, two vertebrae can be fused with bone grafts or metal hardware to stabilize the spine.  To treat people with stenosis, surgeons can remove some portions of the spine to relieve pressure on nerves.

There is, however, a long-standing controversy among spine surgeons over how often surgery is the best option and some say surgeons can be too quick to sharpen their scalps.  Some doctors also feel that we live in a quick-fix society with patients pressuring surgeons to control their pain as soon as possible.

But many surgeries fail to heal the pain.  Doctors even have a name for the problem — failed back surgery syndrome.  Indeed, the exact success rate for surgical intervention is difficult to calculate.  Dr. Richard Deyo, an internist at the Oregon Health and Science University in Portland, notes that approximately 20 percent of surgical patients will have another surgery within a decade, indicating that the first operation was unsuccessful.

Part of the problem is that the exact cause of the pain isn’t always known.  For most back pain patients, Deyo says, doctors cannot discern a specific cause. And advanced imaging techniques — though popular — may be misleading. “When you do magnetic resonance imaging or computerized tomography scans of the spine, you sometimes see horrible things in normal people,” Deyo says. One-fourth of people under 60 have a herniated disc, he says, and half have a degenerated disc.  “And yet, these are people have no back pain!”

Those deformed discs may look like trouble to surgeons, though, so they may remove a disc that wasn’t even causing the pain — leaving the real problem unaddressed. In addition, surgery carries its own small risk for complications, such as nerve damage or tear in the tissue around the spinal cord, which could mean lasting numbness or further surgery.

So how can doctors and patients define a good candidate for surgery? Anderson suggests patients should wait six months, trying other therapies, before opting for an operation.  Deyo says a surgery candidate should have imaging and other studies that match the symptoms and leg pain, indicating the same nerve involvement.  Filler says that one usual test is that if a localized anesthetic directed at the suspected problem does indeed numb the pain, it probably is the correct target for surgery.

There are plenty of treatment options to try before considering surgery.  It is sometimes difficult to evaluate the effectiveness of therapies because most back pain fades regardless of treatment.  And some newer treatments haven’t had much evaluation.  The main thing, experts say, is to be informed.  “There’s been a big increase in the intensity of treatment for back pain,” Deyo says.  That intensity, he says, would better serve many if it focused more on finding the best therapy for each patient — and less on the surgical quick-fix.

To maintain a healthy back

There are things though that you can do to avoid or minimize back troubles.  Here are some tips:

• Keep fit.  Maintaining a healthy weight reduces strain on the spine.  Walking, swimming, and Pilates are low-impact exercises engaging core muscles that support the back. Stretch or try yoga to maintain flexibility.

• Stand up straight. Good posture keeps the spine properly aligned.

• Sit properly. That means both feet flat on the floor, or on a footrest, to keep your knees in line with your hips. A small pillow or folded towel at the small of your back can help support the spine. The computer screen should be at eye level so you don’t have to hunch to see it.

• Lift carefully. Hold objects close to your body. Lift by squatting or kneeling, using the legs, not the back, to rise up.  Don’t lift and twist at the same time.

• Sleep on your side.  Put a pillow between your legs and under your head to straighten the spine.

• Take your vitamins. Vitamin C is important for connective tissue health.  Avoid future osteoporosis by getting calcium for bones and vitamin D to help absorb it.

• Quit smoking. Nicotine prevents discs from absorbing nutrients.

• Ditch the stilettos.  Shoes that don’t properly cushion the foot, such as high heels or flip-flops, can alter posture and stress the spine.

The bottom line is that taking care of your back does take time and some dedication.  However, your efforts can have big payoffs for the health of your back — and the rest of your body!