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What doesn't work for back pain

MagazineJune 2007 (Vol. 18 Issue 3)What doesn't work for back pain

There's plenty that will be suggested that won't do a thing to alleviate the underlying problem

There's plenty that will be suggested that won't do a thing to alleviate the underlying problem. These include:

  • Bed rest - you'd have to look long and hard to find even one doctor who today recommends 'plenty of bed rest'. Latest research suggests the very opposite. Plenty of appropriate activity - which is usually gentle but constant - will do more to ease back pain than bed rest. As many instances of back pain are self-limiting anyway, examples in the past of where bed rest seemed to help were, in fact, nothing more than a coincidence. The patient would have got better anyway, but happened to spend the intervening weeks in bed. In fact, in these cases the back pain would have probably cleared far quicker had the patient been up and about.
  • Analgesics - these are painkillers, which may well be prescribed by the doctor, and if the pain is bad, take them! However, keep in mind that the sudden disappearance of pain doesn't mean the back has suddenly got better. In fact, you're more likely to cause further damage to the back if you can no longer feel the twinges. Still, only a sadist would deny analgesics to someone in pain.
  • Antidepressants - this may seem a strange drug to take for back pain, but many cases are caused by stress and depression. However, most studies agree that antidepressants are rarely the answer, unless the patient is severely depressed and might harm himself. Otherwise, the 'talking therapies', such as counselling and bio-feedback, are far more effective, and without nasty side effects, while the herb St John's wort is effective in cases of mild depression.
  • Traction - this is another long-term standby. Sadly, like so much that it is offered by medicine, it doesn't do much to help. One recent trial found that it was neither good nor bad, a view that's not echoed by osteopaths, who believe that traction can be positively harmful, and may exacerbate any muscle tears.
  • Corsets - one of the major causes of a bad back is a weakening of the muscle groups that support the back. While a corset may ease the symptoms, it's clearly doing nothing to strengthen the muscles. This can be achieved only through exercise, without a corset.
  • Trigger point and ligament injections - these enjoyed a short burst of popularity as the next best thing. Various studies have demonstrated that injections - and it doesn't matter what it is being injected - has little or no beneficial effect.
  • Surgery - this is a complete 'no-no' in almost every case of back problems. Eminent orthopaedic surgeon Dr William Kirkaldy-Willis reckoned that surgery was appropriate in just 5 per cent of patients with back problems, even those with disc herniations. Despite this, many surgeons still favour spinal fusion for chronic low back pain. A knock-out blow was delivered by the Cochrane review five years ago, which concluded after a meta-analysis of earlier trials that there was little merit in the procedure. It's a view that has been echoed by studies ever since. Researchers from the Nuffield Orthopaedic Centre in Oxford have discovered that fusion surgery offers no benefits over rehabilitation. In other words gentle exercise is just as good as surgery, but without all the pain and inconvenience.
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