Understanding Back Pain and Pain Management Options

by Food and Drug Administration (FDA)

During his 27 years as a hospital corpsman, Richard Mettetal lifted injured people and remained suspended by harness from helicopters for long periods. For the 54-year-old Thurmont, Md., resident, the legacy of those years of public service is chronic back pain that has plagued him since 1984.

"It's been so long now, I can't remember when I didn't feel the pain," Mettetal says. "And I'm so angry that I can't do all that I want because of it."

Work-related back pain is among the most common occupational disorders in the United States, according to the National Institute for Occupational Safety and Health in Cincinnati, Ohio. Delay in return to work remains an expensive component in the overall cost of back pain for workers' compensation claims, as well, the institute notes. And back pain is responsible for more loss of work time and increased medical expenses related to treatment than any other ailment, says Robert Shields, M.D., an osteopathic physician practicing general medicine in Plano, Texas.

"This is one of the most common problems I see in my medical practice," he says. "Low back pain strikes 8 out of 10 adults at some point in their lives."

Understanding Back Pain

Back pain comes in two forms, acute and chronic, and is most often felt in the lower back. Acute pain comes on suddenly and intensely, usually from doing something you shouldn't be doing or from doing it in the wrong way. The pain usually lasts a short while. Chronic pain is recurring; any little movement can set it in motion and, for whatever reason, it lingers on and on for what can seem like an eternity.

Although back pain is usually preventable experts claim that 4 out of 5 Americans will experience it at some time in their lives, given that the lower back supports most of the body's weight. The stability of the lower back depends on the integrity of the vertebral bodies and the intervertebral disks.

To understand the many ways you can do injury to your back, consider that each of us has between 24 and 25 bones in and around our backs, including the neck and chest areas, which are held together by ligaments and muscles. Throw in some major nerves, a few disks (which act as shock absorbers), and joints that guide the direction of movement of the spine, and stack them all up, explains Shields. "Expect to twist and bend them in a multitude of directions, and try to imagine what might go wrong."

Shields says you can sprain the ligaments, strain the muscles, rupture the disks, and irritate the joints. While logic would point to injuries from sports or traumatic accidents as the cause of the pain, sometimes the simplest of movements will have painful results. In addition, arthritis, congenital disorders, poor posture, obesity, and psychological problems due to stress can be the source of back pain. Complicating the issue further is the fact that back pain can also directly result from internal problems such as kidney stones, kidney infections, blood clots, or bone loss.

Even with modern technology, however, the exact reason or cause of back pain can be found in very few people, according to the Clinical Practice Guideline for Understanding Acute Low Back Problems, published in 1994 by the Department of Health and Human Services' Agency for Health Care Policy and Research. X-ray examinations explain only a small proportion of the nonspecific complaints doctors receive.

Pain Management Options

Mettetal's troubles began 14 years ago when he nearly collapsed from excruciating pain searing down his leg. His initial diagnosis was a ruptured disk. Since then, even with four major surgeries to repair the problems, his pain has only worsened. Out of desperation, he has tried medications, physical therapies, and pain clinics — all in an attempt to restore some semblance of a functional life.

The Journal of the American Medical Association concluded in a 1996 surgical back pain study that more than $50 billion is spent on the diagnosis and treatment of back pain in the United States. Since the causes are so varied, what works for one person might fail with another.

For most people, drugs work well to control pain and discomfort. But any medication can have side effects. Back pain experts say that over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) — including acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen (Nuprin, Motrin IB and Advil) — can be of value in reducing the pain. More severe pain may require prescription medications such as oxycodone-release (Oxycontin), acetaminophen with codeine (Tylenol with Codeine), and meperidine (Demerol).

Peter Rheinstein, M.D., director of the medicine staff in FDA's Office of Health Affairs, says the many effective NSAIDs available on the market today means there is less need for narcotics. However, he cautions that all NSAIDs cause gastrointestinal bleeding, and advises that patients suffering from other medical conditions need to consult with their doctors about other treatment options for managing their back pain.

"If you have an ulcer, for example, or are taking a blood thinner," Rheinstein says, "you are at an increased risk for gastrointestinal bleeding and should have your doctor prescribe medication that won't aggravate the ulcer or cause any kind of drug interaction."

About the Author

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