Though back pain common, treatments can vary

Does your back ache? If so, you've got a lot of company.

Experts say about 80 percent of us will suffer from lower back pain at some point in our lives. What treatment will give you the most relief depends mostly on what's causing the pain.

Here's a look at the types of pain and what can be done to alleviate it:

For fewer than 10 percent of sufferers, back pain is chronic. But the causes of chronic low back pain tend to be more serious, and the simple remedies that alleviate pain from muscle and ligament strains don't work as well.

A recent discovery by Danish scientists, confirmed by British doctors and published in April's European Spine Journal, found that up to 40 percent of chronic low back pain is caused by infection. This could revolutionize treatment and provide relief for millions.

Far more frequent is acute back pain, which lasts for only a few days or weeks. If your symptoms go away and come back again, it's recurrent. If pain persists for three months or longer, it's chronic.

About 60 percent of those who suffer from acute back pain recover in six weeks or less, but most who have acute back pain will have at least one recurrence.

Muscle and ligament strains and sprains are the cause of most acute back pain. Acute back pain usually gets better without any medical treatment.

The three general categories of low back pain by point of origin are mechanical, nonmechanical spinal problems and referred pain from internal organs. Mechanical pain emanates from a problem with a muscle or ligament, such as a strain or tear. Nonmechanical pain is essentially pain associated with a problem with the spine.

More than 90 percent of lumbago cases — as low-back pain is formally called — are mechanical, and about two-thirds of these are muscle and ligament strains and tears. About 90 percent heal without surgery or other invasive treatments.

Among the nonmechanical spinal problems that cause low back pain are neoplastic disease (tumors on the spine), inflammatory conditions such as spondyloarthritis (arthritis of the spine) and infections.

Referred pain from internal organs comes mostly from gastrointestinal diseases such as inflammation of the pancreas or gall bladder, or from kidney failure.

Treatments run the gamut.

This year, Consumer Reports magazine asked more than 14,000 of its subscribers who said they'd experienced back pain in the last year to rate 23 different treatments. On average, each subscriber had tried five or six.

Hands-on solutions worked best, they said. Chiropractic treatments were favored by 58 percent of respondents, massage by 48 percent and physical therapy by 46 percent.

Manipulation of the spine eases back pain by restoring to their normal position the spinal bones that house the nerves, said Raymond Vactor, director of Wexford Chiropractic in Pine, Pa., and host of radio program “Quantum Health.”

Massage improves circulation of the blood, which speeds recovery of muscles made sore by overexertion. Massage also increases release of endorphins, the body's natural pain medication.

“Massage lessened lower back pain, depression and anxiety and improved sleep,” a 2001 study by the Touch Research Institute of the University of Miami in Florida found.

Physical therapists apply heat, cold and electrical stimulation to sore muscles and lead patients through specific exercises to strengthen the muscles of the lower back. The stronger these muscles are, the less the strain on the disks and joints of the spine. Physical therapy is recommended especially for patients who are recovering from, or who are about to have, back surgery.

Almost 70 percent of the Consumer Reports subscribers said they took an over-the-counter medication such as Motrin, Aleve or Tylenol, but only 22 percent said these were very helpful.

A third of respondents said they took prescription medications, with 45 percent rating them as beneficial. The prescription medicines most often prescribed are more potent anti-inflammatory drugs such as Celebrex and muscle relaxants.

But the survey found only 44 percent of those responding were pleased with the care they got from primary care physicians, who receive relatively little training in musculoskeletal problems.

Their typical response to a patient who complains of low back pain is to write a prescription for a medication that can temporarily ease the pain but does not treat underlying mechanical causes, such as poor posture and muscle imbalances.

“People are not happy with a chemical solution to a mechanical problem,” Schneider said.

They were far happier with the care they got from hands-on treatment — 59 percent were pleased with their care by chiropractors and 55 percent gave high marks to their physical therapist, the survey found.