Back pain is considered as one of the most common medical problems in America. Various literature and research findings reveal that, out of ten Americans, at least eight will experience back pain at some point in their life. This paper critically analyzes back pain as a medical problem, highlighting its traditional and alternative medical options. Various credible sources of information are critically analyzed herein, in an endeavor to develop the skills of rational evaluation of the medical information.
Back pain ranges from a dull ache to a sudden sharp pain that makes movement not easy. It starts quickly as a result of muscle strain and gets worse slowly. However, most back pains heal quickly in a matter of weeks or months. Back pain can either be acute or chronic. Acute pain starts quickly and lasts for less than 6 weeks, while chronic pain lasts for more than twelve weeks (three months) and is less common.
Human back is comprised of several complex structures of muscles, tendons, ligaments, disks and bones. A problem with any of the components can lead to back pain. The most common causes of back pain are strain and structural problems. Strain results from muscle spasm, strained muscles and ligaments, abrupt and awkward movement, lifting a heavy object, or improperly lifting something. Structural problems include ruptured disks, bulging disks, sciatica, and abnormal curvature of the spine, arthritis, and osteoporosis. Other causes include infection of the spine, cauda equina syndrome, bad mattress, and everyday activities and/or poor posture.
In most cases, diagnosis includes physical examination and interview. However, image scans are required in some rare cases. Tests may be ordered if the pain is suspected to arise from an injury to the back or an underlying cause. The image scans include X-rays, MRI or CT scans, bone scan, and electromyography or EMG. These scans are conducted for suspected disk, tendon, nerve, and other problems.
Traditional methods of diagnosis, which are still applied to date, include visual inspection, touching, slow and rhythmic stretching or mobilization, manipulation of muscles and joints, and pressure or indirect techniques.
Two approaches are used in the treatment of back pain: the traditional (physical) approach, and the medical approach. Described herein is a critical evaluation of the approaches, the advantages and disadvantages of each, and a conclusion on the best approach.
The traditional approaches used in treating back pain are physical therapy and massage therapy.
Physical therapy begins with the diagnosis or an evaluation of the situation through touching, visual inspection, stretching, manipulation of muscles and joints, and pressure or indirect techniques.
The treatment includes application of heat, ice, muscle-release techniques, and ultrasound and electrical stimulation, to the back muscles and soft tissues. As the pain subsides, some strengthening and flexibility exercises may be introduced for the back muscles. It also includes the techniques that improve the posture, and the patient is encouraged to regularly practice these techniques even after the pain has stopped in order to prevent its reoccurrence. A manual physical therapy principally employs the use of hand, is more thorough, and focuses on the body as a whole unit.
A modern popular physical therapy is the transcutaneous electrical nerve stimulation (TENS) which uses the TENS machine. The machine delivers electric pulses into the body, which consequently encourages the body to produce more endorphins. However, this approach is not appropriate for those with epilepsy, pregnant women, people with history of heart diseases, and those with a pacemaker.
Physical therapy, however, does not show the root cause of the pain, even if a comprehensive evaluation is carried out. The pain can therefore be reduced, but the root cause is rarely addressed.
Massage therapy is commonly used and can greatly work for most patients, if done correctly (Mueller 2002; Palkhivala 2001). However, it is not a substitute for medication. A variety of techniques are used during the massage session such as stretching and energy techniques. Various benefits are associated with massage. It improves blood circulation, which consequently helps in the recovery of muscle soreness. It also helps in relaxing muscles, and leads to increases the levels of endorphin. Endorphins are the body’s chemicals that manage chronic pain. Generally, massage decreases back pain, decreases depression, and improves a range of motion for various joints. It also improves sleep. By improving blood circulation, massage helps in removing inflammation and causes great relaxation and relief. Massage sessions are conducted on a one-on-one basis, giving the victim an opportunity to converse with the specialist (therapist).
Though very helpful as it seems, the scope of massage is limited and cannot address the problems of back pain fully. Just as the physical therapy, it does not identify or address the root cause of the pain. In most cases, back pain results from physical conditions, which require physical solutions. Postural dysfunctions and muscle imbalances cannot be identified by this approach. Besides, massaging does not give room for the development of very specific, targeted action plans to correct back pain and restore the harmony of the body.
The Medical Treatment
In most cases, the treatment of back pain does not involve medical help. Pain is mostly reduced by over-the-counter painkillers, without any prescription. If the pain does not respond to the painkillers, then non-steroidal anti-inflammatory drugs (NSAID), muscle relaxants, tricyclic anti-depressants, and narcotics, may be prescribed.
The truth of the matter, however, is that these medications do not identify or solve the underlying problems (root causes). Besides, their side effects are worse. Non-steroidal anti-inflammatory drugs such as Advil, Naprosyn, Motrin, Aleve and aspirin are most likely to cause drug interaction problems with the blood pressure medication. This may consequently result in blood clots, heat attacks and ear ringing. Muscle relaxants such as Soma, Valium and Flexeril are habit forming and can interfere with antidepressants. The side effects are depression, insomnia, irregular heart beat, paralysis, hallucinations, and chest pain. The side effects of tricyclic anti-depressants, such as Norpramin, Elavil and Endep, are blurred vision, chest pain, insomnia, pounding heartbeat, and allucinations. Narcotics such as Oxycodone, Codeine, Morphine and Hydrocodone are habitual and interact with tranquilizers, muscle relaxants, and other types of pain relievers. The side effects are drowsiness, fainting, loss of appetite, hallucinations, slow heartbeat, convulsions and dry mouth.
Based on the side effects of these drugs and the fact that they do not identify the underlying problems or the root causes of back pain, I find it difficult to recommend them, and highly doubt if desired long-term results can be achieved.
In some rare cases, surgery can be conducted. Various surgical procedures can be adopted. They include fusion, artificial disk, partially removing a vertebra, and discectomy.
Various approaches, such as the modern medication and the traditional methods, can be used in treating back pain. However, none of these treatments identify and address the underlying issues. Besides, they have limitations and side effects. Medication, as seen herein, is not the best way of dealing with back pain. Also, the modern medicine is based on the traditional approach. Both the approaches confront the body system with some competitive forces, which in turn, make the body to change. In simple terms, change is forced in the body. The traditional approach does not perfectly work as well due to its failure to identify the root causes of the problem.
Medications have side effects coupled with drug interactions. Physical therapy and exercise add stress to the already over-stressed joints and muscles, while surgery may lead to other problems in the long run. Therefore, to effectively deal with the back pain, one needs to identify the cause and design perfect ways of handling it, rather than just handling the symptoms. A safe, drug-free approach is the best option.
Massage therapy has been seen to be effective, though with limitations. If postural dysfunctions and muscle imbalances can be identified and massage applied, great results can be seen. Finally, specific target action plan should be identified to correct the pain and restore body harmony.
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