Back Pain Treatment II

What is the ideal patient process, and what problems do patients and professionals face when treating back pain?

Joel Hellmann, MD:

Dr. Hellmann works for a large health insurance company and lives in Massachusetts.

The ideal process for an educated back pain patient would be to self-treat for a couple of days by appropriately applying ice at regular intervals, appropriately using over the counter anti-inflammatory medicine, and maintaining an appropriate activity level within pain tolerance. If there are signs of improvement with these self-care techniques, the back pain patient would continue to self-treat, and gradually increase a tolerable level of activity, and eventually add activities such as stretching, strengthening, and appropriate exercise. If there was no improvement after a few days of self-care, however, or if the patient had concerns of any kind, it would be important for that person to contact their healthcare provider for a professional evaluation. Immediate medical attention would need to be paid to back pain that was caused by a specific trauma, that radiates to any place other than the back (such as the legs), that causes numbness or tingling, that triggers a change in bowel or bladder habits, or that is so severe that it cannot be relieved.

One of the key elements of back care is that patients are educated about the back and have a clear understanding of what it will take to get better. Part of this understanding includes being realistic about what they are and are not able to do, understanding that all treatments for back pain take time to work, understanding what activities are and are not appropriate as well as the rate at which it is reasonable to expect activity level to increase. It is important that patients be aware of the precautions that need to be taken in order to have and maintaining a healthy back.

Today's society puts pressure on both the patient and provider - providers are expected to both educate and treat patients in discreet periods of time, and patients are expected to return to a normal and productive life as quickly as possible. These pressures challenge our abilities as providers and patients to both provide adequate education as well as allow the body to heal completely. From my perspective this is the most important potential pitfall. There are no shortcuts. Patients must take the time to heal if they want to avoid recurrent and worsened injuries.

We would all like quick relief, a quick cure, and a rapid return to our normal lives, but it simply does not exist for most patients. Back pain patients must rest. They must stick to activities within the limits of their pain, avoid activities known to exacerbate their back pain, stick to a schedule for icing the back for the first 72 hours, and appropriately use over the counter, non-steroidal, anti-inflammatory drugs (NSAIDs) - such as ibuprofen. These recommendations are the hallmarks of initial management and care of muscular injuries of the back (which most are). When conservative care and self-management is recommended, however, people may be disappointed and think that they are not getting appropriate medical care.

In my experience, the people who recover appropriately tend to listen well, ask appropriate questions, have the ability to understand the information that is being given (i.e. No inherent language or comprehension issues/barriers), and do not expect medication to be the quick or the only aspect of care. Back problems can recur and can lead to frustration. In my experience, people with recurrent back problems are often be less patient and want more aggressive therapies - particularly medication. Back injuries require time to heal and the best recommendation that I could make is to be patient with the process and follow the recommendations of your healthcare provider.