Back pain care evolves beyond drugs, surgery, local expert says
By Lauretta Young
My elderly aunt, who fell on her sidewalk in one of our winter ice storms, asked me when self-care is good enough for relieving back injuries compared to a visit to her physician.
She is in her eighth decade and is still curious about what the most recent research says about such issues. When I went to medical school many years ago we never heard about acupuncture or stress relief—we only learned about pain medications and surgery.
Things have evolved so much that in 2010 the Oregon Health Sciences University medical school was one of the first in the nation to offer a core program in integrative medicine. I was the course director for many years. We taught medical students about methods other than drugs and surgery that had strong evidence for outcomes for many common problems.
Unfortunately, not many traditional medical schools include this in the curriculum, making it imperative that patients partner with their traditionally trained physicians to do informed self-care.
I was heartened to read a very focused study in a prominent medical journal last month that highlighted the value of self-care and what I call “other than opiate or other medication” options for low back pain. You can read it online here.
The news about the crisis in the prescription of opiates in our state is alarming—making it vital that each of us is informed and partners with our clinicians when we have pain.
Evidence suggests that unless one has “red flag” issues such as a history of cancer, a severe injury with nerve pain, or problems with bowel or bladder control, that the use of X-rays, MRIs and other imaging techniques is not helpful. This is because everyone’s back looks a little different in imaging devices, and a “normal” back has just as many small abnormalities—intervertebral disc spacing, evidence of arthritic spurs—as backs that hurt. And almost all the found issues are “incidental” and don’t lead to a difference in approach for reducing the back pain.
So, what can you or I do when faced with back pain without red flag concerns?
The best evidence suggests that there are several options we can do to relieve lower back pain. Localized heat seems to be helpful when back pain is acute. Gentle stretching and hydration of tissues also shows strong effectiveness at pain relief. Other options include therapeutic massage, gentle restorative yoga, or a new technique called MELT.
MELT is a simple, gentle, self-care technique done with small soft balls and a soft foam roller. It’s designed to help hydrate connective tissue and reduce inflammation, so joints can have full range of motion without pain. Well-hydrated tissue helps transfer nutrients and waste into and out of cells, so they can repair and heal more efficiently. Hydrated tissue is healthy tissue. This technique has been studied compared to placebo and other options and found to have similar if not better outcomes for pain and function.
Stress reduction techniques are also evidence informed. This should not be interpreted to mean that stress causes back pain but instead that the “fight or flight mode” of nervous system energy causes muscular tightening which aggravates any underlying cause. Learning to increase one’s own rest/digest and repair functions by various stress management techniques will help heal underlying issues and is worth doing when one has back pain.
We are very fortunate in Cedar Mill to have a variety of self-care options. Gentle yoga is available at multiple locations. A recent analysis shows it is as effective as physical therapy in many patients.
We have many superb massage therapists, chiropractors, acupuncture clinicians, and now MELT classes and consults. And we have great family medicine physicians if one needs acute care for the red flag issues or the pain does not resolve.
I am heartened by the flood of new studies about the efficacy of self-care options instead of automatic prescription of opiate pain medications, which don’t solve the problem and can create new ones, such as addictions. Get informed. There is not any direct evidence that any one of these methods is more effective than another. What works for one person may not for another. If you find massage helpful then do that. If you prefer to learn how to use a foam roller in your own home then learn that. But be proactive in your own back care.
Nancy Korf is a certified MELT instructor – to find local classes in our area email her at firstname.lastname@example.org.
Dr. Young offers integrative medicine consults at her Cedar Mill office to learn effective self-care evidence-informed methods to access the rest/digest/repair functionality. She also offers individual stress management consultations. You can contact her at email@example.com.