<>This extremely popular 2017 article on Vox.com the “new science” of low back pain was praised by many because it superficially seems to be very modern and science-y, and it correctly dismisses a number of myths, but I think it’s an exasperating failure. It creates a strong impression of being scientifically rigorous without actually being so. It brims with promising science news about alternative treatments that do not actually stand up to more cynical and experienced analysis. Adding to the façade of scientific credibility, many of the right caveats and disclaimers about the “new science” are technically there — warnings about small effect sizes, mixed evidence, and potential flaws — but these cautions are also belated and consistently understated. The tone is overwhelmingly sunny and naïve, as though we are on the verge of a revolution in back pain treatment thanks to … a bunch of stuff that has been around forever and has clearly not been saving the world from chronic low back pain. >
<>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 >
<>A 2008 study published in the journal Spine found "strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy" for low back pain. After analyzing 23 clinical trials with a total of 6,359 patients, the study authors also found "moderate evidence that acupuncture is more effective than no treatment" in relief of back pain. >
<>Did you know that aside from coughs and respiratory infections, back pain is the most common reason for seeing a doctor in the United States? More than 85 percent of Americans will experience back pain at some point in their life, and back pain is the leading cause of disability worldwide. Yet surgery is rarely needed to treat back pain. So, what’s the answer? Why is it such a problem and, more importantly, how can you prevent it from becoming a problem for you? This article will help answer some of those questions as well as give you some of the best exercises to beat back pain. >
<>2010 — Updated: Added a very beefy footnote about some new research showing that muscle imbalance does not result in higher rates of injury. This almost should have been a new section, but I decided to just make it a ginormous footnote — footnotes are there for delving if you want to, that’s the idea! You can read a summary of the research in the bibliography (see Hides et al), but the relevance to back pain is spelled out in detail here. And it’s interesting. [Section: Diagnosis: Your low back is not fragile!] >
<>I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about me • more about PainScience.com >
<>Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk. >
<>Patient information articles published in both the Journal of North American Spine Society and the Journal of the American Medical Association found evidence that spinal manipulations were safe, effective, drugless forms of professional treatment for both acute (short-term or sudden) and chronic low back problems in adults. (2, 3) Egoscue, another type of postural therapy protocol that focuses on fixing musculoskeletal misalignments, may also be able to help reduce and prevent back pain. >
<>Application of Ice or Heat. Low-quality evidence shows that in the first five days of acute low back pain, the use of heat treatments may be more effective for reducing pain and disability than nonheat wraps, NSAIDs, or acetaminophen, but shows no difference between heat application and McKenzie therapy at seven days.32 A low-quality study found that heat therapy in conjunction with education or NSAIDs is more effective than education or NSAIDs alone at 14 days.33 Ice and heat therapy have similar analgesic effects.32 >
<>It may seem strange to see a psychologist for back pain. But studies show that cognitive behavioral therapy is very effective in the short and long term at helping chronic back pain. For example, CBT may target how people with back pain think about physical activity -- and why they may be avoiding it -- to help change the way they respond to being active. People who do CBT have reported significant decreases in pain and disability. >
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