The Top Cause of Disability Is Usually Mistreated

By Dr. Mercola

Up to 80 percent of adults will experience low back pain at some time in their life.¹ Multiple studies have demonstrated complaints of lower back pain have risen dramatically over the past decades. Ranking 12th as a cause of disability in 1990,² it has risen to the leading cause of disability in nearly all high income countries in the Global Burden of Disease study from 2017.^3,4

Central Europe, Eastern Europe, North Africa and the Middle East experience the same level of back pain disability. Estimates suggest 1 million years of productive life are lost each year in the U.K. due to low back pain, 3 million years are lost every year in the U.S. and 300,000 productive years are lost every year in Australia.⁵

Unfortunately, while the problem is fairly common worldwide, so is the mistreatment of the condition.⁶ A series of papers published in The Lancet⁷ has highlighted the extent to which this treatment is contributing to further pain and, potentially, to the rising opioid epidemic.

Commenting on findings that nearly 37 percent of Americans struggling with back pain avoid seeking professional help for pain relief, Mary Ann Wilmarth, spokesperson for the American Physical Therapy Association (APTA) and chief of physical therapy at Harvard University, said,⁸ "Most people experience low back pain at some point in their lives, but many people don't realize they can prevent or treat the condition with the help of a physical therapist." Indeed, there are many ways to address back pain beside taking dangerous narcotics.

Why Might You Suffer Low Back Pain?

As with all illnesses and injuries, it's important to understand the trigger before diving into treatment. Otherwise, you may be treating the symptom and not the condition, opening yourself up to further injury or illness down the road. There are a number of bones and discs in your back whose abnormality may trigger lower back pain.

However, a majority who experience lower back pain do not suffer from these conditions: Back pain is more commonly triggered by a mechanical issue unrelated to structural change. In other words, you’re more likely to have a muscle problem than a bone problem. According to the National Institute of Neurological Disorders and Stroke,⁹ sprains and strains account for the majority of acute back pain, triggering painful back spasms.

Overuse and misuse of the muscles supporting your spine, poor muscle strength and inappropriate posture while sitting, standing and walking are also reasons why you may suffer from lower back pain. These also indicate changes you might need to make to reduce your risk of debilitating back spasms.

Unfortunately, suffering from lower back pain may make it difficult to perform everyday activities. Your lower back, also called the lumbar region, is a complex structure consisting of vertebra, spinal cord, discs, nerves, ligaments and muscles. Each of these work in concert to achieve pain-free mobility. When there is an imbalance in any of the musculature supporting your lower back, hips, legs or upper back, it may cause an imbalance in the remainder of the interacting muscles.

For instance, when walking with your toes pointed outward, the muscles in your hips and lower back tighten, increasing your risk for lower back pain. Sitting with your shoulders hunched over a computer screen, stretches muscles in your upper back and places added stress on your lower back, increasing your risk for lower back pain.

It also increases your risk for upper back pain. As your head is the single heaviest part of your body impacting your posture, when you walk with your head down, it has repercussions on the rest of your back and hips.¹⁰

The structures of your core, from your abdominal muscles to your back muscles, are all related and helped to support your spine. Therefore, an imbalance in these interactions, which may be triggered by poor posture while sitting or walking, may cause tension or tight muscles in other areas. This can lead to spasms in muscles not designed to carry the weight of supporting your spinal column.

Mistreatment Fuels an Epidemic and Fails to Address the Core Challenge

According to the recent international study published in The Lancet, people in the U.S. experience more of the wrong treatment for lower back pain than any of the other countries studied.¹¹ Despite guidelines, recommendations and studies, physicians still tend to prescribe pain pills instead of movement, physical therapy and exercise, all of which work better.

In the U.S., more than 60 percent of people who see their physician for lower back pain are prescribed opioid painkillers. Guidelines from the American College of Physicians state individuals with lower back pain should first try heat wraps and exercise, and prescription drugs should only be used as a last resort.¹²

Rachelle Buchbinder, Ph.D., director of the Monash department of clinical epidemiology and professor in the Monash University department of epidemiology and preventive medicine, has spent decades working to educate physicians to stop making back pain worse. Author of the call to action in the low back pain series,¹³ Buchbinder commented on the current treatment of back pain:¹⁴

"One of the big problems is that patients aren't always being given the right advice. Rather than evidence-based advice to stay active and exercise, much care for low back pain is of low value and is making the problem worse. There are a lot of misconceptions about back pain. Many people, including clinicians, think that people with back pain should rest in bed, yet we know that resting in bed and not remaining active delays recovery.

The best advice is therefore to keep trying to move normally, remain active and at work. Another misconception is that imaging is needed to identify the cause of back pain and to guide treatment. But even with the most sensitive scans that are available today, we still can't usually identify a specific cause in most people."

Many go to their doctor asking for pain medication after being taught by pharmaceutical advertising campaigns to ask for the latest pill to reduce symptoms. Physicians, often pressured to see as many patients as possible,¹⁵ may find it easier to prescribe a painkiller and an imaging scan, and send you to a specialist, than to educate your lower back pain and how to get relief.

Results from the papers in the Lancet support the assertion that strong drugs, injections and surgery are generally overkill and there’s limited evidence that they help patients.¹⁶

One of the authors of the The Lancet papers, Dr. Martin Underwood from Warwick University, commented on the results,¹⁷ "Our current treatment approaches are failing to reduce the burden of back pain disability.” Instead, with the addition of opioid painkillers to treatment, many are becoming addicted and fueling the opioid and heroin epidemic.

Activity Is the Treatment of Choice

Doug Gross, Ph.D., professor in the faculty of rehabilitation medicine at the New University of Alberta and co-author of the global study on lower back pain, believes the spine needs movement. “Historically, we tended to medicalize back pain,” he says.¹⁸ Patients and physicians have been conditioned to believe pain is serious, needing rest, immobilization, surgery or opioid painkillers. However, each of these have significant adverse effects. Gross adds:¹⁹

"There is no evidence that routine back imaging improves outcomes. It could actually provide misleading information from age-related changes that are common even in people without pain. X-rays or MRI may be required in cases of trauma or accident, or when back pain comes with other symptoms like radiating pain. Otherwise they should be avoided."

The study supports past evidence the treatment of choice for lower back pain is maintaining activity.²⁰ The study also showed over-the-counter pain medication has limited value and is not the first line of treatment. Although the capacity for exercise is different for everyone, it is important to stay as active as possible in your recovery.

If the pain is severe, you may have to ease up on your usual activities, but continuing some activity is necessary. Studies have demonstrated bed rest may actually extend your disability by promoting muscle stiffness and spasms.²¹ In reality, many are treated in emergency rooms and encouraged to rest and stop work,²² when the more successful treatment modalities include light exercise, better posture, core strengthening and improved flexibility.

Opioid Overdoses Leading Cause of Death in People Under 50

Despite the high risk of addiction, opioids and other potentially hazardous drugs are prescribed to many who are present with low back pain. In 1960, 80 percent who entered treatment for opioid addiction had started with heroin. In 2000, 75 percent report their addiction began with a prescription drug.²³ Unneeded and excessive prescriptions of opioid painkillers has contributed greatly to the crisis of addiction and overdose deaths affecting America.²⁴ 

Unfortunately, less than one-third of people in an NPR health poll²⁵ questioned or refused their doctor's prescription for opioids. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 2 million Americans abused or were dependent on opioids in 2014, and more than 1,000 land in emergency rooms every day as the result of abusing or misusing prescription painkillers.²⁶ The CDC also reports deaths involving prescription opioids were five times higher in 2016 than in 1999.

In keeping with the higher rate of abuse and misuse, sales of these prescription drugs have also quadrupled between 1999 and 2016. The drugs most commonly involved in opioid overdose deaths include oxycodone and hydrocodone, both prescribed for muscle and back pain.²⁷ Deborah Taylor, senior vice president and executive director of Phoenix House Mid-Atlantic, a nonprofit drug and alcohol rehabilitation organization operating in 10 U.S. states, notes:²⁸

"The progression of addiction and the behavior that comes with it is pretty standard regardless of where you're born, how much money you have, how old you are and your race or nationality. You can be the smartest person in the world — and the minute that chemical hits your bloodstream, you lose control of what it does in your body. You can't control it. Nobody can control it. I don't care who you are. It's not controllable."

According to data compiled by The New York Times,²⁹ deaths attributed to opioid overdoses top 59,000, 19 percent more than the year before. The medical examiner for Cuyahoga County, Ohio, commented the number of young people dying in the U.S. from opioid overdose is the same as the number of casualties in the entire Vietnam conflict,³⁰ raising opioid overdoses to the leading cause of death in Americans under age 50.

Signs You May Have More Than Muscle Tenderness or Spasms

Although back pain is definitely serious, as it affects your everyday life and can suck the joy out of your days for a week or more, it is often not dangerous. In other words, the severity of your pain does not indicate your condition is medically dangerous.

However, there are some signs and symptoms that might suggest the pain you're experiencing is not common low back pain from a muscle strain or sprain, but might be something more serious requiring physical assessment and treatment. These signs include:^31,32,33,34

At-Home Back Pain Relief

You may be able to prevent and treat lower back pain using drug-free strategies to remain active, improve core strength, use correct posture and reduce inflammation. For example, consider addressing your: