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Orthopedics and Health

Back pain symptoms, relief

Red Flags For Back Pain

By Dr. W. Gifford Jones

April 2, 1995

What should your doctor do if you suffer from back pain? Equally important, what should you do if the doctor doesn't do it? Thousands of North Americans succumb to back pain every year. But too often both patients and doctors push the panic button too soon. Errors can be avoided by three red flags.

A panel of U.S. experts reviewed over 3900 case studies of back pain. From it the U.S. Department of Health produced a guideline for treating this common malady.

Experts stress that the majority of patients are relieved of most pain within four to six weeks. And within three months 90 percent can be back to work.

But what normally happens? Doctors too frequently order bonescans, Xrays, myelograms and magnetic resonance imagingprocedures. Experts contend this is usually a waste of money.

Physicians err in other ways. They frequently advise patientsnot to return to work until the pain has gone. Or until they see aspecialist. But the waiting period can be weeks. Besides,investigating the cause of back pain can sometimes make it worse.

Dr. Claire Bombardier, Director of Clinical Epidemiology atthe University of Toronto, was a member of the expert panel. Shesays, "back pain is such a common problem that it is almost a partof normal living".

Consider that one out of 10 people at any given point of timeare suffering from some kind of back trouble. That acute back painaccounts for 4 per cent of patient care. This makes it second onlyto respiratory infections in causing visits to doctors' offices.

So why do doctors treat this trouble the wrong way? A primereason is that physicians receive little training in back pain inmedical school. An odd situation when back pain affects so manypeople. In addition the terminology used for back pain alsoconfuses doctors.

Dr. Bombardier remarks, "It's like a jungle, and opinions vary depending on who you speak to. Someone will say it's a musclespasm. Someone else will call it sciatica. Another will label itfibromyalgia. And because most people get better, you really neverknow what it was!"

The panel urges doctors to look for three "red flags". Thismeans asking the right questions to alert them to seriousconditions.

One red flag is raised if pain radiates down the leg to belowthe knee. Or if pain is associated with muscle weakness. Or a lossof sensation, numbness and tingling. These symptoms indicatepressure on the sciatic nerve.

A second flag rises if the patient has lost weight, has afever or pain at night. This may point to cancer or infection inthe bone or kidney. If these symptoms are absent the chances ofthese problems being present are nearly zero.

The last flag flies if a fracture is suspected. It's notnormally a problem as there should be evidence of a blow or fall.But elderly patients can suffer fractures for unexplained reasons.

Dr. Bombardier says it shouldn't take more than five minutesto investigate these symptoms and eliminate them. Then tell thepatient there's no need for any investigation.¡"After all" Bombardier adds, "it helps to remember that thechance of there being a serious problem are only one in 30,000!"

But the dilemma of back treatment isn't confined to doctors.A huge stumbling block is that many patients want something doneimmediately. The result is needless radiation or otherinvestigative procedures.

There is some good news. Doctors are getting the message topatients about the benefits of exercise. And not prescribingprolonged periods of bed rest.

Walking, bicycling and swimming are ideal forms of exercisefor those suffering from back pain. Other exercises can be added tostrengthen back and abdominal muscles once the acute pain hassubsided.

The panel advises against pain medication unless necessary.But if needed acetaminophen and non©steroidal anti©inflammatorydrugs are preferable to muscles relaxants.

They concluded that surgery was needed in only one per cent ofcases. That the side©effects of oral steroids, injections of localanesthetics and corticosteroids were too serious to suggest theiruse. And that there was no sound evidence that spinal traction,acupuncture, transcutaneous electrical nerve stimulation (TNS) orlumbar corsets were of value.

Remember, back pain is like the common cold. Nature cures itin time. So don't push the doctor into tests before they're reallyneeded. Chicken soup or a scotch©and©soda is often the besttreatment for the common cold. They might even soothe a sore back!


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

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod