Back Pain

Daniel Pendick

New recommendations aim to improve safety of pain-relieving spinal steroid injections

Each year, several million people with neck or back pain get injections of anti-inflammatory steroid medications. When they work (they don’t always), such injections can bring profound relief. But injecting these medications into the spine can cause partial or total paralysis, brain damage, stroke, and even death. Case reports beginning in 2002 highlighted serious problems linked to spinal steroid injections. In 2014, the FDA started requiring a warning on the labels of injectable steroids. A Viewpoint article in this week’s Journal of the American Medical Association spotlights new safety recommendations to help prevent these rare but real problems. The new recommendations are part of the FDA’s Safe Use Initiative.

Howard LeWine, M.D.

Physical therapy as good as surgery and less risky for one type of lower back pain

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

One type of lower back pain, called lumbar spinal stenosis, can be painful and potentially disabling. An operation known as laminectomy or decompression is sometimes done to ease the pain of lumbar spinal stenosis. Physical therapy can also help. Researchers compared the results of laminectomy to those of a special physical therapy program among nearly 170 Pittsburgh-area men and women with lumbar spinal stenosis. The two approaches worked equally well — pain declined and physical function improved. There were more complications in the surgery group. Since there are no hard and fast rules for choosing the right treatment for lumbar spinal stenosis, the results of this study offer some guidance — try a well-designed physical therapy program first.

Howard LeWine, M.D.

Early scans for back pain add cost but offer little benefit for seniors

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Older adults with new back pain usually end up getting a CT scan or MRI. That’s often a waste of time and money and has little or no effect on the outcome, according to a new study from the University of Washington. The results of the study contradict current guidelines from the American College of Radiology. The guidelines say that it’s “appropriate” for doctors to order early MRIs for people ages 70 and older with new-onset back pain, and many doctors do just that. The study, which followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain, found that people who got early back scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit.

Nancy Ferrari

Acetaminophen may do little for acute back pain

Nancy Ferrari, Senior editor, Harvard Health

When back pain strikes, all you want is relief—as quickly as possible. Many folks turn to over-the-counter pain relievers to help take the edge off and keep them moving. Acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen, aspirin), are common and reasonable choices. Australian researchers tested how well acetaminophen worked for back pain that comes on suddenly (so-called acute back pain). Not much, it turned out. Among people who took acetaminophen as needed or on a three-times-a-day schedule, it took about 17 days for the pain to go away completely. Among those who took a placebo, it took 16 days. Does this mean that you shouldn’t bother to use acetaminophen for back pain? Not necessarily. But it might be worth trying cold, heat, and light physical activity.

Howard LeWine, M.D.

Bad weather isn’t to blame for your aching back

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

It’s not uncommon for people to blame the weather for making their arthritis or back pain flare up. A team of Australian researchers has one word for that: bunk. They followed nearly 1,000 people who were seen for acute low back pain in several Sydney primary care clinics noted the weather conditions when the back pain started, as well one week and one month earlier. And they found … nothing. No connection between back pain and temperature, rain, humidity, or air pressure. The results were published online in the journal Arthritis Care & Research. This isn’t the first word on the pain-weather connection, and won’t be the last. If animals can sense earthquakes, then it may be possible for people with back pain, arthritis, or other types of pain to sense changes in the weather that the rest of us don’t notice. But we need good proof.

Daniel DeNoon

Back pain often overdiagnosed and overtreated

Daniel DeNoon, Executive Editor, Harvard Heart Letter

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.

Daniel Pendick

Acupuncture is worth a try for chronic pain

Chronic pain in the muscles and joints can make life miserable. Standard treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. But when they don’t, acupuncture is an option with a good track record that’s worth considering. Research from an international team of experts adds to the evidence that it does provide real relief from common forms of pain. The team pooled the results of 29 studies involving nearly 18,000 participants. Overall, acupuncture relieved pain by about 50%. The study isn’t the last word on the issue, but it is one of the best quality studies to date and has made an impression. For new pain, an acupuncturist should not always be the first stop. It’s important to get a clear diagnosis of what is causing the pain to rule out serious medical conditions that should be treated right away—and then seek out acupuncture if appropriate.

Edward Phillips, M.D.

Build your core muscles for a healthier, more active future

Edward Phillips, M.D., Assistant Professor, Harvard Medical School

Many exercise programs these days spotlight the ever-present abs (abdominal muscles) but pay little attention to the other muscles that form the body’s core. Yet building up all of your core muscles is essential for staying strong and flexible and improving performance in almost any sport. It’s also vital for sidestepping debilitating back pain. Your core includes your back, side, pelvic, and buttock muscles, as well as the abdominal muscles. The core forms a sturdy central link between your upper and lower body. Much like the trunk of a tree, core muscles need to be strong yet flexible. A strong, flexible core underpins almost everything you do, from everyday actions like bending to put on shoes to on-the-job tasks, sports and sexual activity, and more. A strong core can also help you keep your back healthy or recover from back pain. It’s unwise to aim all your efforts at developing rippling abs. Overtraining abdominal muscles while snubbing muscles of the back and hip can set you up for injuries and cut athletic prowess.

Heidi Godman

4 tips for preventing neck strain when using a tablet computer

Heidi Godman, Executive Editor, Harvard Health Letter

For all too many people, using a tablet computer is a pain in the neck, shoulders, and back. Why? Widely popular tablets like the iPad, Nook, Kindle Fire, and Xoom are so light and easy to handle that you can hold one on your lap or in your hand. That can put you in a position that’s bad for your neck, shoulders, and back. In a study of 15 experienced tablet users, Harvard School of Public Health researchers found that working with a tablet held on the lap or placed flat on a table makes the neck bend much more than does working with a desktop or notebook computer. Neck-wise, the best tablet orientation was having it propped up on a table. Next time you expect to be working with a tablet computer for more than a few minutes, place it on a table and use a case that holds it at a comfortable viewing angle. Shift your hands, your weight, or even stand up when you can. And take a break every 15 minutes.

Julie Silver, M.D.

Chicken Soup for the Soul and Harvard Health serve up inspiration, information

Julie Silver, M.D., Chief Editor of Books, Harvard Health Publications

A new series of books is bringing readers the kind of inspirational stories that have made Chicken Soup for the Soul books international bestsellers plus with trusted health advice from Harvard Medical School. The combination of stories providing hope, inspiration, and great person-to-person advice plus straight talk and life-changing medical information from Harvard doctors will help readers live healthier, more satisfying lives. Each book focuses on a single topic. The first four will be available beginning May 22, 2012. They are Chicken Soup for the Soul: Boost Your Brain Power! by top neurologist Dr. Marie Pasinski; Chicken Soup for the Soul: Say Goodbye to Back Pain! by leading physical medicine expert Dr. Julie Silver; Chicken Soup for the Soul: Say Goodbye to Stress! by noted psychologist Dr. Jeff Brown; and Chicken Soup for the Soul: Say Hello to a Better Body! by respected internist Dr. Suzanne Koven.