The current literature on lower back pain recommends drug-free care for lower back pain which can have many causes. The Annals of Internal medicine in February of 2017 recommended avoiding expensive tests such as an MRI and offered a list of things you could try for lower back pain. Chiropractors use many of these and holistically evaluate and treat patients with lower back pain and have earned an excellent reputation for their approaches and results in lower back treatment. Ironically, most doctors ignore these recommendations resulting in the unnecessary and sometimes harmful use of these tests or medical procedures such as injections to the spine. Who you see first will determine the cost, effectiveness, safety, and complexity of your problem. Chiropractors keep it simple by only testing after conservative care fails to work instead of testing up front which adds unnecessary costs. The ACA recently through their handsdownbetter.org website offered this recent well-referenced article. Need an appointment today? Book online here. Back Pain: Prevention and Conservative Treatment Back pain is a fact of life for many people. Research shows that up to 80% of the population will experience back pain at some point during their lives. It is also one of the most common reasons for visits to the doctor’s office.1 Sometimes back pain is sharp and intense, caused by a wrong movement or an injury, and heals in a few days or weeks. Others experience back pain as a chronic condition, seriously altering their ability to work and enjoy time with family, friends and other leisure activities—leading in some cases to depression. A global survey of health conditions identified back pain as the single most disabling condition worldwide.2 Moreover, as lifestyles have become more sedentary and the rate of obesity has risen, back pain has become increasingly prevalent, even among children. Spinal health is an important factor in preventing back pain as well as maintaining overall health and well-being. The American Chiropractic Association (ACA) encourages people to take steps to improve their spinal health and avoid injury. Things such as better nutrition, exercise, ergonomic workspaces and proper lifting and movement techniques can go a long way in helping people to strengthen their spines and potentially avoid serious injury and chronic pain. A Closer Look at Back Pain The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks and irritate joints—all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements (such as picking up a pencil from the floor) can have painful results. In addition, arthritis, poor posture and lack of movement, obesity and psychological stress can cause or complicate back pain. While most cases of back pain are mechanical or nonorganic (not caused by serious conditions such as inflammatory arthritis, infection, fracture or cancer), it can also directly result from diseases of the internal organs such as kidney stones, kidney infections, blood clots or bone loss. Support for Conservative Care Treatment for back pain has come a long way. It was once believed that taking pain medication and getting some rest and relaxation were the best course of action for a bout of low back pain, but nowadays research and guidelines3 support first trying drug-free conservative options for pain management while remaining as active as possible during recuperation. The epidemic of prescription opioid overuse, as well as research showing that even common over-the-counter pain relievers have limited effectiveness in relieving back pain4, has led several respected healthcare groups to recognize the value of a conservative approach to common conditions such as back pain. Notably, the American College of Physicians (ACP), the largest medical specialty society in the world, updated its back pain treatment guideline in 2017 to support a conservative approach to care.3 Likewise, the Centers for Disease Control and Prevention released updated guidelines for prescribing opioids in 2016 that promote the use of nonopioid and nondrug alternatives first for the treatment of chronic pain.5 The Joint Commission, which accredits every major U.S. hospital, also recognizes the value of non-drug approaches to pain management by including chiropractic and acupuncture in its pain management standard.6 Beyond the risks of overuse and addiction, prescription medications that numb pain may also convince a patient that a musculoskeletal condition such as back pain is less severe than it is or that it has healed. That misunderstanding can lead to overexertion and a delay in the healing process, or even to permanent injury. Conservative Care Costs Less With high costs associated with prescription drugs, chiropractic’s conservative approach makes economic sense as well. One study found that spinal manipulation for neck and back pain was cost-effective when used either alone or combined with other therapies first.7 Another study, based on data from Washington state workers, found that 42.7 percent of people who visited a surgeon first for work-related back pain eventually had surgery, compared with only 1.5 percent of those who visited a chiropractor first.8 For more information on prevention and wellness, or to find a doctor of chiropractic near you, visit www.HandsDownBetter.org. References Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin, 2007; May;25(2):353-71. Global Burden of Disease 2015: Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct 7; 388:1545–1602. Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med, 2017;166(7):514-530. Machado GC, et al. Non-steroidal Anti-inflammatory Drugs for Spinal Pain: A Systematic Review and Meta-analysis. Annals of the Rheumatic Diseases. Published online first, Feb. 2, 2017; doi: 10.1136/annrheumdis-2016-210597 Centers for Disease Control and Prevention. “CDC Guideline for Prescribing Opioids for Chronic Pain,” 2016. https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf. The Joint Commission. "Non-pharmacologic and non-opioid solutions for pain management," Quick Safety, August 2018. https://www.jointcommission.org/-/media/tjc/documents/resources/pain-management/qs_nonopioid_pain_mgmt_8_15_18_final1.pdf Michaleff ZA, et al. Spinal Manipulation Epidemiology: Systemic Review of Cost Effectiveness Studies. J Electromyogr Kinesiology, Oct 2012; 22(5):655-652. Keeney et al. Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Spine, 2013; 38(11):953-964. Brought to you by the American Chiropractic Association (ACA) and reviewed by the ACA Editorial Advisory Board. This information is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. If you have specific questions, contact your doctor of chiropractic. For more information on injury prevention and wellness, or to find a doctor of chiropractic near you, visit HandsDownBetter.org.