<>These powerful painkillers may not be all that: In a study published in JAMA, fast-acting opioids like morphine and oxycodone were no better than non-opioid medications (like Tylenol or an NSAID) in improving function in moderate to severe back pain. Talk to your doctor about the option that’s best for you. Don’t miss these 24 things pain doctors won’t tell you. >
<>When structural problems are exaggerated, you also get a plague of bogus explanations and solutions based on that. Spines do degenerate, but not for the reasons most people think they do: genetics is by far the biggest factor in degeneration,27 not your posture, your office chair or mattress, your core stability, or anything else that low back pain sufferers have taught to blame their pain on. >
<>That’s a huge topic, but here’s one simple example of an extremely common problem with back pain science: control groups that don’t control. Rather than comparing a treatment to a good, carefully selected placebo, most studies use a comparison to a treatment that is allegedly neutral, underwhelming, or placebo-ish. That makes the results hard to interpret: if each works about the same, it could mean that the treatments are equally effective … or equally ineffective! So much back pain science has this problem — or any one of a dozen other weak points — that you can effectively ignore at least 80% of all back pain research, because it’s so far from the last word on anything. Good science is essential to solving these problems, but really good studies are also difficult to design and rare. BACK TO TEXT >
<>According to Susi Hately, owner of Functional Synergy, Inc., in Alberta, Canada, and author of several international best-selling yoga books, yoga can be very therapeutic for people with back pain as well. A review of scientific studies published in 2013 in the Clinical Journal of Pain found strong evidence that yoga can help reduce chronic low back pain. Yoga may help improve back pain by loosening tight muscles, building strength and range of motion, and improving breathing, explains Hately. Yoga also focuses on relaxation, which may help to relax your muscles as well as reduce pain perception. >
<>Once in a great while some cranky reader (always a guy) writes to tell me, “I didn’t learn anything from your book.” I’m a little skeptical about that, and it’s always tempting to start quizzing! There’s a great deal of information here, including analyses of recent research. Sure, readers who have already done a lot of reading about back pain might already be familiar with a lot of it — but you will know that going in, of course, and you’ll find the nuggets of new information and perspective that any keen reader is always looking for. BACK TO TEXT >
<>Few people need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn't responded to other therapy. >
<>Laboratory tests such as complete blood count with differential, erythrocyte sedimentation rate, and C-reactive protein level may be beneficial if infection or bone marrow neoplasm is suspected. These tests may be most sensitive in cases of spinal infection because lack of fever and a normal complete blood count are common in patients with spinal infection.15 Because laboratory testing lacks specificity, MRI with and without contrast media and, in many cases, biopsy are essential for accurate diagnosis.15 >
<>The use of injections and procedures in and around the spine is limited as such treatments often provide only temporary relief. However, they can be important in helping diagnose structural causes in pain and assisting the physical rehabilitation when other methods have failed. The various injection procedures are costly and have potential side effects, which should be discussed in detail before proceeding. Often, a pain specialist or back specialist will also employ rehabilitation and counseling by non-physician personnel such as therapists, counselors, and patient educators. >
<>Lose excess weight. As we gain weight, stress and pressure on the lower spine and back muscles increases. The heavy weight at the front of the body can cause an increased arch in the spine and may lead to injury and compression of the discs and nerves. Losing weight reduces the tendency to arch the back and relieves pressure on the lower spine and nerves. >
<>Research is being conducted on certain treatments that stimulate nerves to reduce chronic back pain. Your doctor may consider adding acupuncture to your treatment plan if you aren't finding relief with more conservative care. Another method your doctor might suggest is transcutaneous electrical nerve stimulation (TENS), during which mild electric pulses are delivered to the nerves to block incoming pain signals. >
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