A New York Times article a couple of years ago declared, “How do you solve back pain? Don’t ask your doctor.”
It’s a shocking statement meant to grab people’s attention, and it does that pretty well. It also may seem like there is an element of truth to it.
Back pain is complex and not always well understood. Even with modern technologies like MRIs, CT scans, myelograms, discograms, X-rays, electromyography, nerve conduction studies, and on and on we can’t always pinpoint an injury responsible for the pain.
Back pain is not very specific. One type of back pain may feel very much like another, even if the core problem is different. There are myriad muscles, tendons, ligaments, nerves, tendons, joints, discs, and other potential pain generators in and around the spine, any one of which could potentially be painful. If the wrong one is treated, it won’t fix your pain.
The back doesn’t always hurt when it is supposed to either. Often, the back doesn’t hurt while you are doing an activity that brings on the pain. The pain will only come on later – even a day or more later. So the association between cause and effect isn’t always clear.
And even when we do look, we almost always find abnormalities in the spine that may or may not be related to your pain. Worn out discs, scoliosis, or bone spurs are commonplace, even in patients who have no pain whatsoever. So just because your MRI reports some findings, they may not be what is responsible for your symptoms.
All this can give back pain sufferers a sense of hopelessness. “If we can’t identify a specific injury, or if we do find abnormalities but there’s nothing to be done for them, what chance is there of fixing my back pain?” That is why asking your doctor about fixing your back pain may seem like a fruitless task.
However, it’s not that doctors don’t know how to help back pain – it’s more often that the answers are difficult. For example:
- Helping mechanical back pain can be a long and arduous process.
- Quick fixes seldom work in the long term.
- No one treatment works for everyone.
- Surgery can help some causes of back pain. It cannot help others. And surgery comes at a cost.
- Nothing is going to make your back bullet-proof.
Surgery is very good at fixing some kinds of problems. In some cases, surgery may be the only thing that can reliably help. In other cases, surgery might be beneficial, but other treatments may also work. In some cases, surgery is not indicated. Your surgeon will determine whether or not there is a structural injury that surgery can correct. If there is not a clear surgical indication, you can still get better but it helps if you understand what you have to do. And even if you are a candidate for surgery, you will have to work on your back to maximize your recovery from surgery and then continue working in order to maintain any gains you have made.
If you have back pain, be prepared to have to work to get better. Taking good care of your spine is a lifelong process. Don’t be afraid to talk to your doctor. Your doctor is your partner in that process and can point you in helpful directions. But be prepared to have occasional bouts of pain no matter how hard you work at it. Just know that if you do take care, even if you do get more episodes of back pain they will be less severe and won’t last as long.