Consumer Reports Insights

Relief for Aching Backs

Tuesday, June 2, 2009; 10:53 AM

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 the respondents had tried five or six different treatments. They rated the helpfulness of those treatments and their satisfaction with the health-care professionals they visited.

Hands-on therapies - chiropractic manipulation, massage and physical therapy - were among the top-rated. 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.

1. WHERE TO GO FOR TREATMENT

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 the 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 might be okay for a recurrent, familiar back problem.

Most of the 35 percent of the respondents who chose not to see a health professional had severely limiting pain for less than a week.

Research suggests that chiropractic manipulation can reduce acute low-back pain. Fifty-eight percent of survey respondents who tried chiropractic manipulation said it helped a lot, and 59 percent were "completely" or "very" satisfied with their chiropractor. For example, chiropractic care has kept Albert McCann, 54, of Lakeland, Fla., working as a petroleum transport engineer, driving a semi and using 20-foot-long hoses several times a day. Fifty-five percent of consumers reported being highly satisfied with treatment by a physical therapist.

Lifestyle changes can help, too. Forty-four percent of survey respondents found exercise helpful, making it the top self-help measure.

2. BE WARY OF OPIOID PAIN RELIEVERS

The low-back-pain survey found that more than 50 percent of those given a prescription drug received an opioid pain reliever, even though there is very little research to support the use of opioids for acute low-back pain. Opioids may be more effective than a placebo in reducing chronic low-back pain. But clinical trials have shown that about half of the people who take them for pain suffer adverse effects such as drow-siness, respiratory depression (a potentially dangerous breathing problem) and gastrointestinal symptoms such as constipation, heartburn, cramping, nausea and vomiting.

There are almost always better solutions than opioids for low-back pain. For most people, the best first-line medicines are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Depending on the circumstances, second-line medications, including muscle relaxants, tricyclic antidepressants and anti-seizure drugs, can help.

3. USE CAUTON WITH SURGERY

Your doctor might suggest you see a surgeon if back pain is unrelenting and no other treatment seems to work. The Consumer Reports Health Ratings Center conducted a separate survey of almost 1,000 consumers who have had back surgery in the past five years.

Just 60 percent of the 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 a 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).

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 had not been 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.

Copyright 2009, Consumers Union of United States Inc.

For more guidance on back pain, go to ConsumerReportsHealth.org. More-detailed information is available to subscribers to that site, including consumer ratings and the medical evidence for 23 back remedies.


© 2009 The Washington Post Company