Back Pain

If you’re suffering from chronic back pain, it’s only natural to assume you have an injury. But recent research has suggested that our feelings, emotions, and behaviors may have much more to do with chronic back pain than any detectable problem with the spine — and this has just been confirmed by a study in JAMA. Here, we’ve listed what really works to help combat chronic back pain — and what you can do today to rid yourself of it.

Some aspects of chronic back pain really are “in your head” — but that doesn’t mean you’re making it up. Rather, research has shown that when pain is chronic, the brain processes it not via the usual “pain” circuits, but via the “emotion” circuits. This means that you can actually reduce chronic pain by changing your psychological and emotional response to it. We’ve listed several techniques that have been proven to reduce chronic back pain.

Many common cold and flu medications and prescription-strength pain relievers contain acetaminophen (Tylenol) as one of their active ingredients. If you take several of these drugs at once during a bout of cold or flu, you might accidentally take more than the safe dose of acetaminophen, potentially causing liver damage. It’s always best to read the labels — and to keep in mind that most winter viruses get better on their own with rest, fluids, and time.

When it comes to pain management, focusing only on reducing the intensity of pain may lead to treatments that do as much harm as good. Ideally, pain-management plans should be tailored to each patient and include a range of therapies that not only reduce pain but also help improve pain-related quality-of-life problems.

The Alexander Technique (AT) was developed by a Shakespearean actor who discovered that muscle tension and poor posture caused him to lose his voice when he performed. His methods are still used today to help people unlearn negative habits and patterns of movement and learn how to return the body to a relaxed state. Although AT still enjoys a lot of popularity among artists and performers, it can help anyone move through life with more ease and less pain.

Like an expensive car, your brain functions best when it gets “premium fuel” — that is, nutritious, minimally processed foods. The emerging field of nutritional psychiatry is finding that what you eat directly affects the structure of your digestive tract, the function of your brain, and, ultimately, your mood. Give “clean eating” a try and see how you feel.

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.

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.

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.

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.