Okay, this is, in my humble opinion, pretty damn interesting.
For years, I’ve felt (and discussed with my patients) my belief that there is just something fundamental that we (the collective “we” of the medical community) are missing when it comes to understanding back pain.
One of the fundamental truths of medical practice is that whenever you see a lot of different treatments being used for a problem, most likely all of them have pretty darned similar less-than-stellar results. It makes sense, when you think about it. If there was one treatment that had great results and stood out from the rest, well then that is the treatment that would be used almost all of the time. Since however, treatment A is little if any better than treatment B, which is little if any better than C, and D, etc., oftentimes the choice of treatment ultimately boils down to individual preference based upon factors such as where one trained, statistically insignificant anecdotal experiences, etc.
Well, back pain is a lot like that. Lots of different types of medical (and pseudo-medical) practitioners out there seeing patients for back pain, doing lots of different types of “treatments”, and for the most part results are pretty similar, and often pretty disappointing.
Fortunately, for acute back pain, most of the time, it gets better regardless of what is done or isn’t done. This occurs in about 90% of cases if I recall correctly (and I’m too lazy to google this right now). There are some general guidelines out there for conservative care, that if followed seem to work out pretty well for most folks, regardless of whether they go see the family medicine doctor, the neurosurgeon, the chiropractor, the school nurse, the local voodoo specialist, the massage therapist, their priest, etc., or if they go see nobody at all. It just gets better in most cases. In most cases it just doesn’t make a damn bit of difference.
Now that isn’t to say that if you have acute back pain you should avoid going to the doctor (If you’re wondering if you should go see your doctor for this, or any other cause, go see your doctor!). “Most” is not synonymous with “All”. Every once in a while, acute back pain is from some particular specific cause that may indeed respond quite differently depending upon what is or is not done for it. I know I’m biased as a family physician, but I think this is one of the great values of have a good relationship with a primary care doctor. He/she can help separate the zebras from the horses.
Anyway, it’s all well and fine to say “Thankfully most acute back pain will get better.” But what about those cases that don’t get better? What about those folks who go on to develop chronic back pain? Well that is a different kettle of fish altogether.
Chronic back pain is serious business. As with acute back pain, there is a veritable slew of various people offering all sort of treatments, etc. A lot of people suffer for great lengths of time. A whole lot of loss of quality of life, productivity, money,…you name it. People desperate for relief often find themselves repeatedly on the operating table being cut open, developing dependence upon habit forming narcotic pain medicines, etc. It really can ruin people’s lives. Some folks fortunately get relief with surgery, but for too many, their problems get no better and/or only get worse. It can lead to long term disability, loss of income, destroyed relationships, etc. It truly can be tragic.
As I mentioned at the start of this post, I’ve always been bothered with the nagging feeling that when it comes to back pain “We just aren’t getting something.” Heck, most likely it’s more like we just aren’t “getting” a bunch of somethings. I truly believe that when it comes to back pain (and a whole lot of other stuff), someday in the future, people will look back upon those of us practicing medicine today and snicker a bit, marveling at how stupid and silly we are about a lot of things. We do this ourselves, smugly looking back upon medical practice a century or two ago and laughing at some of the silly notions they had, so I suppose it is only fitting that folks in the future do the same to us.
So, what’s the point of this post? Why, after a pretty long period of inactivity has Dr. Sam decided to bother to log onto his blog and blather on like this?
You can go read them for yourselves (and I recommend you do, as it is quite fascinating), but in a nutshell, some (awesome) folks in the frozen north (Denmark), spent years looking into the possibility of bacterial infection being behind a substantial number of cases of chronic low back pain, and it looks like their hunch was correct. This is a BIG DEAL folks!!!! In that second article linked, it shows how they were able to successfully treat a pretty substantial number of chronic low back pain sufferers with a simple antibiotic.
This reminds me a lot of the story of the Aussie doctors who proved that most stomach ulcers are related to a bacterial infection (Helicobactor pylori). Completely changed the practice of medicine.
If this chronic low back pain stuff pans out, it too will be practice-changing and will make a HUGE difference in the lives of a HUGE number of people. Kudos to our Danish friends!!! I agree with the brit doc quoted in the first linked article who was talking about this stuff being potentially Nobel Prize worthy.
Anyway, go read the linked articles. This is good stuff!!! Yay Science!!!