The Enigma of Back Pain

The problem of back pain is that each individual type of back clinic describes the cause of back pain and treatment options from a different point of view. For example, a medical doctor might describe back pain as a degenerative process of the soft tissues of the back. A chiropractor might describe back pain as a result of a misalignment of the vertebral column. A practitioner might describe the cause of back pain as a nutritional deficiency. An osteopath might describe the cause of back pain as a muscular imbalance. A back pain expert might describe a very different course of treatment based on their training and the diagnosed cause of your problem.

There is nothing wrong with a back pain expert subscribing to one point of view, if that is the way they were trained and that's what they believe in. But many doctors and osteopaths have concluded that after talking with hundreds of thousands of back pain sufferers and the thousands of professionals who treat them, it has become clear that nearly all the methods used to treat epidemic-sized ailment do work - at least for some of the people, some of the time. The $100,000 question that rarely gets asked, let alone answered, is which treatment works for whom and when?



Few studies comparing large numbers of back pain patients and the various treatments have been conducted and properly analyzed. Typically, physicians may be a proponent of certain treatments based on their training and clinical "observations". Dr. Alf Nachemson, a Swedish orthopedic surgeon, has reported that he did not notice any differences in treatment outcomes among the standard treatments for back pain: manipulation (chiropractic, physical therapy, NO TREATMENT AT ALL!). Clearly the cause of back pain and appropriate treatment for it remains an enigma. We should note from Dr. Alf Nachemson's observations that only these three treatments were observed.

Since Nachemson's observations and revelations, more comparison studies have been done. Today, the following professionals have had some success in treating acute and chronic back pain: spine doctor, spine surgeon, orthopedic surgeon, chiropractor, physical therapist, osteopath, massage therapist, acupuncture, and nutritionist. One relatively recent study compared standard discectomy procedures to microsurgery for disc removal. This study showed a faster recovery time and fewer side effects for patients who underwent the microsurgery procedure for disc removal. A Netherlands back pain study compared patients who had standard physical therapy to those in an exercise program. A physical therapy program is more likely to include exercises where patients isolate and challenge one muscle or a small group of muscles, while an exercise program is more likely to include more of a full body workout. The Results of the Netherlands study indicated no differences among the two groups of patients.

Though results continue to come in, no independent, non-partisan group has come up with the method or resources to evaluate all the different treatments for neck pain and back pain, one to the other.

In truth, the task is extremely difficult, especially since many back pain programs continue to integrate more than one type of therapy to back pain patients.