If back pain has nagged you daily for years and years you may be familiar with this scenario:
You walk into your primary care physician’s office and explain your decade-long problem with low back pain. You rattle off symptoms like shooting pain, muscle spasms and sleep loss. The physician scrawls down a few details and, by the time your appointment ends 12 minutes later, she has handed you a prescription for Vicodin.
One of the most troubling trends when it comes to chronic back pain is over treatment. A recent study found concerning things like:
- 629% increase in spending on epidural steroid injections
- 423% increase in opioid prescriptions for back pain
- 307% increase in lower back MRIs
- 220% increase in spinal fusion surgeries
Those are stunning increases, yet the same study indicates those procedures did nothing to improve patient outcomes. Sometimes the fault lies with hasty or uninformed decisions by the treating physician. In other cases it’s the patient who is demanding a prescription or an MRI scan.
Our philosophy is that the best treatment for chronic back pain — unrelated to a trauma or some other condition — is conservative.
Here is what studies — and our own clinical experience — say are telltale signs that your chronic back pain is being over treated:
1. YOU ARE NOT ADVISED TO TRY AN ANTI-INFLAMMATORY DRUG OR ACETAMINOPHEN
A recent study found that physicians suggest treating chronic back pain symptoms with non-steroidal anti-inflammatory medications (NSAIDs) or acetaminophen far less now than they did a decade ago.
If your doctor doesn’t advise you to try anti-inflammatories for your back pain before more aggressive treatments, steer clear. So much of back pain results from inflammation — and these medications may offer short-term help.
2. YOU’RE OFFERED A PRESCRIPTION FOR A NARCOTIC PAIN MEDICATION TO TREAT YOUR CHRONIC BACK PAIN
At the same time NSAID use for chronic back pain went down, narcotics prescriptions for back pain went way up. Using narcotics to treat chronic pain is not well studied.
What we understand about using prescription narcotics to treat pain suggests some relief — but only in the short-term or for serious conditions like cancer. And the longer you use narcotics, the higher your risk of dependence, abuse, heightened sensitivity to pain and overdose.
3. YOUR PHYSICIAN DOES NOT SUGGEST PHYSICAL THERAPY OR OTHER FORMS OF EXERCISE
Exercise is a truly potent painkiller. Never mind that it unleashes a wave of feel-good hormones in the body — when it’s done specifically to relieve chronic back pain it strengthens the back and improves flexibility. And — all that movement and all those chemicals reduce the brain’s perception of pain.
If your physician or specialist is not prescribing physical therapy or some other form of exercise as one of the first lines of defense against chronic back pain, try someone whose philosophy involves low-intervention.
4. YOU ARE OFFERED AN MRI OR CT SCAN RIGHT AWAY
Did you know there are people walking around right now with bulging or degenerative discs — or spinal stenosis — who experience no pain or symptoms whatsoever? Yet if they were to see these conditions on a scan, it might raise flags and begin a conversation about more intensive treatment. Many spinal issues that appear dramatic on an MRI or CT scan are essentially innocuous conditions in a percentage of people. Not to mention having access to those scans increases your chances of having surgery. Unless your physician suspects something serious is causing your back pain, try and avoid getting scans.
5. YOUR PRIMARY CARE PHYSICIAN REFERS YOU TO A SPECIALIST BEFORE TRYING A LOWER INTERVENTION APPROACH
If your primary care doctor refers you to a specialist too quickly — for example before you’ve tried physical therapy or NSAIDs — then you are likely being over treated. Once you’re referred to specialist, the likelihood that you will be treated with injections or surgery go up — as does your chance of getting your spine scanned.
Have you tried low-intervention and still have serious pain? Contact us online or give us a call and we will be happy to help.