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Back pain: the dangers of surgery

MagazineDecember 1993 (Vol. 4 Issue 9)Back pain: the dangers of surgery

If you have low back pain, instead of rushing to your own doctor, first try the most conservative management you can

If you have low back pain, instead of rushing to your own doctor, first try the most conservative management you can. Dr William Kirkaldy-Willis, retired emeritus professor of the Department of Orthopaedic Surgery at the University of Saskatchewan College of Medicine in Canada and a world-renown advocate of conservative management, believes that back pain can only be sorted out with a multidisciplined approach and that conservative management can help many of those with problems formerly thought to be the province of the surgeon. In Kirkaldy's view, only about 5-10 per cent of patients with disc herniations require surgery.

* Consider working with a fully trained and qualified, experienced chiropractor, osteopath or physiotherapist first. The Manga Report (August 1993), put together by Professor Pran Manga, former director-general of the Health and Social Policy Directorate of the Canadian government, analyzed the published evidence worldwide. His conclusion: 'Spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for lower back pain.' One such study (The Lancet, 28 July 1990) showed a seven-point advantage of chiropractic treatment over conventional hospital management on a Oswestry disability index.

* Don't consent to a myelogram under any but the most desperate circumstances and only after you've had a second expert opinion. MRI and CT scanning have largely replaced myelograms for all but certain specific conditions.

* Surgery will potentially help only disc herniation, instability, stenosis, spondylolisthesis, and scoliosis. If you don't have a definitive diagnosis of any of the above, don't consent to be put under the knife.

* Find an orthopedic specialist in sympathy with the teachings of Kirkaldy-Willis. If you can afford it, get hold of Managing Low Back Pain by Kirkaldy-Willis and Burton (Churchill Livingstone, Edinburgh and New York), which will help to put you on an equal footing with your orthopedic specialist.

* Find a 'back school' which will educate you about the cause of your pain, good daily low back care and an early return to full functioning.

* Contact grass-roots organizations like the Action Group for Relief of Pain and Distress in the UK (Hills View, Aller Road, Dolton, Winkleigh, Devon EX19 8QP). (For information on self-manipulation, send lb2.50 for their book 'A Safety Net'.)

Reading the large print

Back pain: the dangers of surgery

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