BACK PAIN: Will It Go Away By Itself?

English: Thai Massage (Photo credit: Wikipedia)

BACK PAIN.

One of the most interesting things about chronic back pain is that over time sufferers underestimate their pain.  They think it was better before, and worse now.  They also think it will get better, and for the majority it doesn’t.

If back pain sufferers do admit their suffering, they often end up in the offices of surgeons.  Back surgery for chronic back pain is a two-edged sword.  Fusing part of the back may relieve pain at that location while increasing pressure farther up or down the spine.  Rarely is it a treatment for a pain free life.

Conservative therapy for back pain revolves around pain killers, often the now famous oxycontin and oxycodone.  These numb the central nervous system, lessening the pain while lessening the person’s ability to function.

So what else is there?  Plenty, but it is rarely taught or practiced.  Many patients are given physical therapy without ever being taught McKenzie exercises.  Far fewer ever hear the name Feldenkreiss, and disturbingly few are familiar with the term “neutral pelvis” (the point at which the person feels no pain).

Once in a blue moon will a patient be told that, even though calcification is present, most of their pain is associated with the back spasming around the injury to keep it from moving.  Relieve the spasm, and relieve much of the pain.

If the injury is old, the habitual back spasm may hold the back in place well after the bulging disc or acute injury has repaired itself.  In that situation it is possible to give profound relief with bodywork.

Patients reluctant to pay out-of-pocket for bodywork (we’re talking massage, or lengthy chiropractic, or rolfing,  not a whack-slap-out-you-go) should consider the following:  “The beneficial effects of massage in patients with chronic LBP lasted at least 1 year after the end of the treatment.”  That isn’t a testimonial, that is the assessment of the Cochrane meta-analysis on all the studies done on chronic back pain.   Here are two of the abstracts available at my webpage on back pain.

Spine 2002 Sep 1;27(17):1896-910

Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.
Furlan AD, Brosseau L, Imamura M, Irvin E.
Institute for Work & Health, Toronto, Canada. afurlan@iwh.on.ca
BACKGROUND: Low back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. Proponents of massage therapy claim it can minimize pain and disability and speed return-to-normal function. OBJECTIVES: To assess the effects of massage therapy for nonspecific LBP. SEARCH STRATEGY: We searched MEDLINE, Embase, Cochrane Controlled Trials Register, HealthSTAR, CINAHL, and dissertation abstracts through May 2001 with no language restrictions. References in the included studies and in reviews of the literature were screened. Contact with content experts and massage associations was also made. SELECTION CRITERIA: The studies had to be randomized or quasirandomized trials investigating the use of any type of massage (using the hands or a mechanical device) as a treatment for nonspecific LBP. DATA COLLECTION AND ANALYSIS: Two reviewers blinded to authors, journals, and institutions selected the studies, assessed the methodologic quality using the criteria recommended by the Cochrane Collaboration Back Review Group, and extracted the data using standardized forms. The studies were analyzed in a qualitative way because of heterogeneity of population, massage technique, comparison groups, timing, and type of outcome measured. RESULTS: Nine publications reporting on eight randomized trials were included. Three had low and five had high methodologic quality scores. One study was published in German, and the rest, in English. Massage was compared with an inert treatment (sham laser) in one study that showed that massage was superior, especially if given in combination with exercises and education. In the other seven studies, massage was compared with different active treatments. They showed that massage was inferior to manipulation and transcutaneous electrical nerve stimulation; massage was equal to corsets and exercises; and massage was superior to relaxation therapy, acupuncture, and self-care education. The beneficial effects of massage in patients with chronic LBP lasted at least 1 year after the end of the treatment. One study comparing two different techniques of massage concluded in favor of acupuncture massage over classic (Swedish) massage. CONCLUSIONS: Massage might be beneficial for patients with subacute and chronic nonspecific LBP, especially when combined with exercises and education. The evidence suggests that acupuncture massage is more effective than classic massage, but this needs confirmation. More studies are needed to confirm these conclusions, to assess the effect of massage on return-to-work, and to measure longer term effects to determine cost-effectiveness of massage as an intervention for LBP.
Publication Types:

Review

Review Literature

PMID: 12221356

Summary: A number of treatments may be effective for low back pain with apparent disagreement between studies due to grouping all lower back pain into the same category. Degenerative disc pain should be separated from sciatica and chronic muscle spasm in future studies. Individualized treatment plans beginning with less intrusive mobilization before manipulation would greatly increase chiropractic outcomes. Long term studies incorporating patient self-treatment with passive (neutral pelvis) as well as active (hydrotherapy, lifestyle) interventions are still lacking.   Eur Spine J 2003 Apr;12(2):149-65   Low back pain: what is the long-term course? A review of studies of general patient populations. Hestbaek L, Leboeuf-Yde C, Manniche C. The Backcenter, Ringe Hospital, Odense University Hospital, 5950 Ringe, Denmark, hestbaek@vip.cybercity.dk It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim – attractive as it might be to some – may not reflect reality. In order to investigate the long-term course of incident and prevalent cases of LBP, a systematic and critical literature review was undertaken. A comprehensive search of the topic was carried out utilizing both Medline and EMBASE databases. The Cochrane Library and the Danish Article Base were also screened. Journal articles following the course of LBP without any known intervention were included, regardless of study type. However, the population had to be representative of the general patient population and a follow-up of at least 12 months was a requirement. Data were extracted independently by two reviewers using a standard check list. The included articles were also independently assessed for quality by the same two reviewers before they were studied in relation to the course of LBP using various definitions of recovery. Thirty-six articles were included. The results of the review showed that the reported proportion of patients who still experienced pain after 12 months was 62% on average (range 42-75%), the percentage of patients sick-listed 6 months after inclusion into the study was 16% (range 3-40%), the percentage who experienced relapses of pain was 60% (range 44-78%), and the percentage who had relapses of work absence was 33% (range 26-37%). The mean reported prevalence of LBP in cases with previous episodes was 56% (range 14-93%), which compared with 22% (range 7-39%) for those without a prior history of LBP. The risk of LBP was consistently about twice as high for those with a history of LBP. The results of the review show that, despite the methodological variations and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored. Future research should include subgroup analyses and strive for a consensus regarding the precise definitions of LBP. PMID: 12709853 [PubMed - in process] Spine 2002 Sep 1;27(17):1896-910

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