How Effective Are Medical Treatments For Back Pain?

Monday, July 13, 2009

Jolie Bookspan, M.Ed, PhD, FAWM

Many well-known conventional treatments for injured athletes and military personnel came from ways to keep wounded combatants able to continue fire, not to maximize their long-term survival or later health.

Years of my career laboratory research was improving physical training for athletes and military, and developing injury protocols that were healthy, not just a remedy for the moment. I also found that much good sports medicine for athletic motion was never applied to the more common body motions needed all day. Not only can the athletes benefit, but everyone else. Many patients and readers have success using my improved non-surgical methods, and write us their stories (click for reader stories). Many more have success without writing about it. Other readers asked about various medical (surgical/drug) treatments, and why don't I use them.

Thank you to my colleague Fabrice Czarnecki. M.D. emergency room physician, for sending me a report, recently published in a prestigious medical journal. The work was a systematic review of the "benefits and harms of nonsurgical interventional therapies for low back and radicular pain."

The medical methods they looked at were local injections, botulinum toxin injection, prolotherapy, epidural steroid injection, facet joint injection, therapeutic medial branch block, sacroiliac joint injection, intradiscal steroid injection, chemonucleolysis, radiofrequency denervation, intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation, Coblation nucleoplasty, and spinal cord stimulation.

Their results: "For sciatica or prolapsed lumbar disc with radiculopathy, we found good evidence that chemonucleolysis is moderately superior to placebo injection but inferior to surgery, and fair evidence that epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. We found fair evidence that spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent radiculopathy, though device-related complications are common. We found good or fair evidence that prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Insufficient evidence exists to reliably evaluate other interventional therapies.

What does all that mean? They summed it up in their conclusions: "Few nonsurgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials."

Report name: Nonsurgical interventional therapies for low back pain: a review of the evidence for an American pain society clinical practice guideline.
Published in Spine. 2009 May 1;34(10):1078-93.

Medical reports on these methods (as well as general strengthening exercises) frequently show what is called a scattershot success - meaning if you try it on hundreds of people, it's bound to hit a few of them. Often these hits (moderate improvements) are about the same as chance or as time passing and the person heals on their own over the weeks of the treatment and recovery. Use those medical treatments if you believe in them and prefer them.

I prefer a direct approach:

Instead of shots to anesthetize the area, or surgery to remove or fuse an area, retrain movement to be healthy so that you no longer injure the area and it can heal.
Instead of medicines to mask the damage you cause, stop the damage.
Stopping damage does not mean stopping movement, activity or fun. Use healthy body mechanics to become able to do more than before.

Continue Activities You Love

Notice Damaging Body Mechanics

Fixing Damage Without Surgeries, Injections, or Drugs