No real cure for an aching back
For most problems not caused by illness, best thing is to stay active
Published: Sunday, November 4, 2012 at 3:00 a.m.
Last Modified: Thursday, November 1, 2012 at 9:45 p.m.
Megan Hall blames her aching back on the back bend she did five years ago at an exuberant hot-yoga class. Since then, the Santa Rosa dental hygienist has tried everything from deep massage to cortisone injections to mail-order back contraptions to ease the chronic pain in her lower back.
Meningitis cases cause worry over spinal shots
When news broke of a deadly outbreak of fungal meningitis tied to contaminated steroids used in spinal injections, Dr. Kirk Pappas at Kaiser Permanente in Santa Rosa started hearing from worried patients who'd had similar shots.
The outbreak was linked to a contaminated drug made in Framingham, Mass., by the New England Compounding Center.
"Everyone's anxiety is pretty high about this stuff," said Pappas.
"I got an email from a guy who had an injection a year ago. But he was still worried. I told him what I have everyone. This drug came from a compounding pharmacy, and we don't order drugs from a compounding pharmacy. We get our drugs from big-box drug factories that follow FDA (U.S. Food and Drug Administration) requirements. Ninety-nine percent of hospitals and clinics in California do the same thing."
Compounding pharmacies traditionally make drugs prescribed by doctors for individual patients whose specific needs can't be met by commercially available drugs. The U.S. Food and Drug Administration regulates big drug companies, but not compounding pharmacies.
"There are times when you need compounded drugs that can't be produced by a big factory drug company," he added. "But when you compound medications that are injected deep in someone's spine in a vascularized area that feeds directly to the brain and you've injected bacteria, you can have problems."
The sports medicine doctor has been giving cortisone injections for 15 years. But he doesn't often prescribe them for ordinary low-back pain.
"A shot is not going to fix their back," he said. "Less than four percent of the people I see for lower back pain will up end with an injection."
For people with spinal stenosis and sciatica, an epidural shot may ease the "referred pain into the legs, not the back pains."
— Susan Swartz
When she feels it coming on, she does floor stretches and then ices her lower back.
The worst is when she's been standing most of the day at work and then keeps standing, while grocery shopping or cooking dinner.
“If I don't get down on the ground,” she said, “I can't handle it.”
Hall, 53, is in good, albeit miserable, company. Eighty percent of Americans suffer back pain that doesn't come from a broken bone or an illness but is at some point strong enough to make them call a doctor.
And here are some painful truths about this common malady: Lower back pain is largely inevitable and there is no real cure.
“Back pain is a part of life. It's part of aging,” said Dr. Kirk Pappas, a sports medicine doctor at Kaiser Permanente in Santa Rosa.
“The spine ages,” he said. “The joints settle. It's like that old cushion on your couch that gets flattened out.”
Low back pain is a chronic recurring condition, said Pappas, “and that's the part that humans don't like. They want you to fix it. I want to fix it, too. Your doctor, your massage therapist, your hot-stone healer, your whatever, they want to fix you, too.
“Some patients will see 17 different people for their back and will get relief,” he added.
“And then they'll say it was acupuncture or it was Advil that helped my back pain. But it is a rare exception to have a miraculous fix.”
One reason is that it's difficult to pinpoint the actual pain generator.
“It could be coming from the joints, ligaments, muscles, discs,” Pappas said.
So, what to do when your back acts up? Stay active, for one thing.
Avoid prolonged bed rest, which is what doctors used to commonly order for back pain before they recognized that staying in bed can lead to the deterioration of muscles and body functions.
“Each day in bed you lose conditioning of the muscle and it takes two days to recover,” Pappas said.
As for whether it's best to apply cold or heat or take one pain pill over another, it's pretty much an individual choice.
“A patient's own beliefs are more powerful than my words,” Pappas said. “For me to say I know you like ice, but I prefer heat will not make heat work for him.”
The same is true with pain medication.
“In terms of simple, over-the-counter medication for pain relief,” said Pappas, “there is no good literature that says one is better than the other.”
Physical therapist Sharon Barbee helps run a weekly back clinic at Kaiser in Santa Rosa where patients with chronic back problems learn how to sit, stretch, improve posture, work on good abdominal tone and discuss more back-friendly ways to sleep or pick up a toddler.
“The majority of people with back pain have the kind that comes and goes,” said Barbee.
“They have good days and bad days. Our job is to help them to be active despite the back pain. Be active to the degree you can without bothering it. The condition may never go away, but you can possibly get to where you can feel quite decent.”
Hall has stayed active despite her years of back pain, continuing to cycle and teach spin classes at her gym.
“I stopped spinning for a while and it made it worse,” she said. “If I do nothing, I hurt more.”
A recent MRI image showed that Hall has spinal stenosis, a narrowing of the spaces in the spine that puts pressure on the spinal cord and can pinch nerves, causing pain down the leg.
While this condition can often be relieved by cortisone shots, they haven't worked for Hall and her doctor has suggested she consider a minor surgical procedure that can relieve pressure on the affected nerves.
“I talk to so many people, including a lot of my dental patients, and it's amazing how many people talk about having back pain,” said Hall.
Pappas, who is a runner, has his own back issues and relies on heat and a couple of favorite stretches when he gets a flare-up.
And he tells himself what he tells his patients: “There are some aches and pains that we can't cure.”
(Susan Swartz is a freelance writer and author based in Sonoma County. Contact her at email@example.com.)
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