Inside Medicine: Back pain best treated with time
05/09/2013 12:00 AM
05/08/2013 3:00 PM
After "throwing his back out" lifting a bookcase, Sergio has visited the clinic three times in the past two weeks.
Each time he was concerned that he had not yet recovered.
Sergio is not alone; back pain is one of the most common concerns that bring people to the doctor. Over our lifetime, 85 percent of us will have back pain at an overall national cost of more than $100 billion per year in treatments and lost work.
There is so much back pain in our society, and we have so little success treating it, that there are many medical experts all offering cures. These include primary-care doctors, orthopedic surgeons, neurosurgeons, rehabilitation experts, physical therapists, chiropractors, acupuncturists and many more.
There have been loads of research on nonspecific back pain and, while we have no cure, we have learned some important lessons. For example, the vast majority of back pain, while uncomfortable, is self limited and will not get better any quicker with treatment.
Bed rest is out – those put to bed rest recover more slowly than those who remain somewhat active. Treatments intended to decrease pain such as muscle relaxants, corsets and braces, traction, spinal manipulation, acupuncture, herbal treatments, antidepressants, and TENS units all have disappointing results.
There are small studies that suggest that each of these is effective, but when we look at all these similar studies together, the treatments were found to be either not at all effective, or only minimally effective.
Still, studies suggest that despite no definitive treatments, more than half of patients with run-of-the-mill back pain will have X-rays (46 percent), CT scans (18 percent) and MRIs (33 percent).
Why do we do so much when the benefit is so small? Some have suggested that doctors use all these treatments because people are impatient and want prescribed treatments, rather than being told that a tincture of time will result in full recovery.
Now that doctors are being graded by their patients with such methods as patient-satisfaction surveys, the fear among doctors is that people won't be satisfied unless they receive something from the visit.
So, it was surprising to read a study from the University of Minnesota that looked at satisfaction among nearly 3,000 people who had received medical care.
Surprisingly, those who received more treatments and/or tests had no higher satisfaction with their care than those who received only discussion and education.
Surprisingly, the factor that best predicted patient satisfaction was time spent with the doctor – not tests or drugs ordered. It is a hard lesson to teach young doctors, but rather than teaching them "don't just stand there do something," we need to teach them "don't just do something, stand there and listen."
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at firstname.lastname@example.org.
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