New study reveals what you should try 1st if you experience low back pain

When should you seek out a doctor if you've got low back pain? Two studies out of the University of Washington say seeing a physician may not be your best first option.

In fact, both studies show that limiting your activity, taking opioids, or having surgery may not work for many patients.

Researcher Bianca Frogner is the director at the Center for Health Workforce Studies at the University of Washington.

But besides studying it, she's also got a personal experience with low back pain. She was moving boxes into her new house, when she said, "My legs just kind of buckled out from under me, and I just felt this excruciating pain going from my back down to my legs."

Instead of seeing a doctor right away, she sought out a physical therapist.

In a recent study, Frogner's team analyzed 150,000 insurance claims and found that patients who saw a physical therapist first for low back pain lowered their probability of getting opioids prescribed by 89 percent, advanced imaging by 28 percent and an emergency room visit by 15 percent.

"A physical therapist is telling you to move your body in certain ways, and it seems almost too easy that the only thing you need to do is stretch," Frogner said.

Yet, Frogner says, physical therapy worked for her without drugs or a doctor.

Most back pain is short-term, but about 20 percent of people affected by acute low back pain go on to develop chronic low back pain that can last a year or more.

"The body reacts with muscle constriction, which decreases the distance between vertebrae, and a vicious cycle is created," said Dr. Alessandro Napoli, an interventional radiologist.

The basic treatment for relieving acute back pain from strain or minor injury is a limited period of rest for 24 to 72 hours. An ice pack can be helpful, as can aspirin or another non-steroidal, anti-inflammatory drugs to reduce pain and inflammation.

Physical therapy may be prescribed for back pain like massage, ultrasound, whirlpool baths, controlled application of heat and individually tailored exercise programs to help you regain full use of the back. Strengthening both your core, abdominal muscles as well as the muscles in the back can help stabilize the spine.

Pain management specialist Judith A. Turner is with the University of Washington, School of Medicine. She reviewed many studies and found that surgery is not indicated for most low back pain problems.

"All too often, people get the advice to stop everything that they're doing, rest, take some opioid medication. And, we know now that's the wrong treatment," Turner said.

Instead, she found most people responded better to exercise and cognitive behavior therapy, which includes breathing, relaxation and pain-coping skills. The therapy trains the brain to respond differently.

Yet - experts say insurance coverage often dictates what treatment people receive for pain.

"I think there just needs to be more studies to understand whether we're really incentivizing patients to see the best provider for the kind of care they need," Frogner said.

While you may have the right to see a physical therapist without a doctor referral, your insurance policy may require one so it's best to check first. Many patients don't take advantage of this because their insurance copays may be higher for a physical therapist than for a doctor.

There are also other options showing promise where conservative treatment isn't effective. A study at the Sapienza University of Rome looked at a minimally invasive procedure for herniated discs for patients who didn't respond to treatments like exercise and medications.

The patients underwent a procedure in which, with the help of CT imaging, a needle is guided to the location of the bulging disc and nerve root. A probe then delivers pulsed radiofrequency energy to the area over a 10-minute period. Even without touching the disc, the pulsation helps resolve the bulging disc.

Of the 80 patients treated, 81 percent were pain-free one year after a single 10-minute treatment session, six patients required a second pulsed radiofrequency session, and 90 percent of the patients were able to avoid surgical treatment.
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