By Dr. W. Gifford Jones
March 15, 1992
What is the best cure for the common backache? Bed rest with hot packs? Non-steroidal anti-inflammatory drugs? A scotch and soda? A disk operation? Or would it be more helpful for everyone if surgeons took "Course 101 in Psychology" to help them understand this common malady? And also heeded the advice of my old German Professor.
Dr. Alf Nachemson is a prominent Swedish orthopedic surgeon at the University of Goteborg. He recently told doctors attending the Canadian Medical Association meeting that the costs of treating back pain have reached staggering proportions. And that the time had come for all of them to bone up on psychology.
Nachemson claims that Sweden spends 10 billion each year on back problems. That in the U.S. this figure jumps to 100 billion. In Canada, one province, Ontario, spends 70 per cent of Workers Compensation Board Claims for back strains.
The problem is getting worse everywhere. In 1970 in Sweden one per cent of the labour force missed work due to low back pain. But by 1987 it had risen to eight per cent with workers off the job for an average of 34 days.
North American doctors do not dispute these figures. According to the American Academy of Orthopedic Surgeons, low back pain is second only to the common cold as a cause of employee absenteeism. They estimate that four out of five people will experience back pain at some time in their lives.
Faced with such staggering figures one would think doctors could easily pinpoint the cause of back pain. This isn't the case. Dr. Michel Dupuis of the University of Montreal says one of the problems is that doctors confuse the issue by using various names for the same clinical symptoms.
For instance, when 40 orthopedic surgeons were asked to provide a definition of lumbar instability they gave 40 different answers! Most doctors simply do not know where the pain comes from. Dr. Nachemson puts himself in that category.
DR. Nachemson, however, cites one study that throws some light on the subject. Dr. Stanley J. Bigos of the University of Washington studied 3,000 workers over an eight year period at the Boeing assembly plant in Everett, Washington.
Factors such as age, workload, muscle strength and fitness had little correlation with the complaint of back pain. But previous lumbar pain and smoking appeared to be factors in whether or not workers reported this symptom.
Yet one fact kept reappearing. Bigos found that workers were six times more likely to report back trouble if they regarded their jobs as unfulfilling and lacking in assets. Nachemson concluded a course in psychology was just as important as a knowledge of biomechanics.
So how do you treat low back pain? Nachemson stresses the first rule is to prescribe bed rest for no more than two days. Just as a ship deteriorates when tied to a dock so does immobilization wreak havoc with the back.
Bed rest is probably harmful because muscle strength and tone are lost along with calcium from bones. Bed rest also increases pain sensitivity.
Activity on the other hand triggers the release of endorphins, the body's own natural morphine-like substance.
Dr. Nachemson has little good to say about traction, spinal fusion and most of the time-honoured methods of treatment. Nor is he enthusiastic about the use of expensive iso-machines. He claims that for the ordinary backache the best prescription is education, exercise and encouragement.
Doctors, he suggests, should start with a thorough examination of the patient. A prime way to ease patients fears is to tell them what they don't have! The fact that 95 per cent of disk lesions don't require surgery is encouragement in itself.
I will always remember an old German professor at the Harvard Medical School. On the final day of lectures to our class he imparted some sound advice. In his heavy German accent he remarked, " Always be sure to make your patient feel as though he were zee only pebble on zee beach".
Making patients feel their welfare is important often makes a difference. One group of hospital workers suffering from back pain were told by hospital administration that they were an important part of a team and their jobs were waiting for them . This approach decreased costs and time lost by 70 to 80 per cent! As the Russian proverb says,"A kind word is better than a big pie."
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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