What to Expect When You Visit Your Doctor for Back Pain

close-up of doctor examining patient's back
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Every day, about eight million people in the United States (many who are children and adolescents) have back pain for the first time in their lives.

If or when this happens to you or someone you care about, what should you do about it? Do you really need to see a doctor? What should be your approach to pain relief? And when would you need x-rays or MRIs?

Let's take a look at the basics on what you can expect from medical treatment for your first time non-traumatic back pain.

But before we get to that, let me offer a bit of good news. The AHRQ, a government health agency tasked with "advancing excellence in health care," as stated on their website, reports that acute low back pain (which is defined as an episode that lasts less than a month) in many cases resolves itself. AHRQ says that a complete resolution of pain, disability, or limited motion and missed work is decidedly not out of the question, and that most people improve rapidly after that first incident.

Should You Even Visit a Doctor?

Knowing what the AHRQ says, should you visit your doctor when you experience back pain? Generally speaking, back pain is not serious, and it is only very rarely life threatening. That said, it can and often does disrupt quality of life.

For your first experience with back pain, checking with your doctor is probably a good idea. Figure out who the best back doctor to go to is.

He or she will ask you some basic questions as a way of narrowing your symptoms down to a diagnosis. 

These questions may include: What were you doing when the pain started? Did the pain come on gradually or suddenly? Where do you feel the pain and does it radiate out? What does it feel like? A number of terms for describing your symptoms exist, so have at it.

You might feel electrical symptoms such as pins and needles, burning, shock and the like, or you may have a dull ache. The more you can thoroughly and accurately describe your pain symptoms, the better. Your description gives the doctor something to go on when making a diagnosis and subsequent treatment recommendations.

Other things your doctor will likely want to know are the timing of the pain. In other words, when does it come on and when is it relieved, what you physically do at work, and more.

Diagnostic Tests—Do You Need Them?

Many doctors are in the habit of ordering complete diagnostic workups for their patients with neck or back pain. These can include x-rays, MRI, and possibly blood tests.

These tests are not always necessary. The American College of Radiology says that uncomplicated acute low back pain with or without radiculopathy are benign (and self-limiting) conditions and as such don’t warrant diagnostic testing. 

For example, if you have “red flags” such as unrelenting pain at night, pain that is worse in the morning but gets better as the day progress, or pain that lingers for longer than a week, your doctor may suspect that your pain is caused by a systemic disease.

Similarly, if you have osteoporosis, you’ve had some trauma, or you’ve used steroids for a long time, films may actually be useful in the diagnostic process.

A 2016 German study published in the journal Deutsche medizinische Wochenschrift found that while 10 percent of back pain patients do get diagnostic films, up to a third of these workups may be completely unnecessary.

Will My Doctor Prescribe Pain Medications?

Many doctors prescribe pain medication for first time back patients. Any kind of pain medication comes with potential side effect, but recently the FDA changed the risk profile of Advil (ibuprofen). Research they reviewed indicated that even a few weeks of use could significantly raise the risk for serious health conditions such as heart attack.

Sadly, many doctors give narcotic pain relievers right off the bat, even to their patients with mild, self-limiting pain.  My opinion is that such practitioners are doing a serious disservice to these people because of the increased risk for addiction associated with taking narcotics.

A systematic review published in the May 2016 issue of the Journal of the American Medical Association found that while the ability of opioid analgesics to relieve acute low back pain is unknown, there is no evidence of a meaningful effect on chronic non-specific lower back pain. One of their big reasons for this was that opioids may yield a bit of short-term relief, but that’s about it. 

How can you extrapolate JAMA’s findings on opioids for chronic back pain to your acute (if you have one) situation? You might consider this from a risk to benefit angle. Taking narcotics for acute back pain may mean that you’ll risk becoming addicted for just a small amount of overall pain relief.

At first, it may seem like you need everything you can get in order to deal with what you’re going through, but you do have other options. As mentioned above, there are different classes of pain relievers such as non-steroidal anti-inflammatories (of which ibuprofen is one) and Tylenol (acetaminophen). In other words, not all pain meds are narcotic in nature. And non-drug forms of pain relief such as acupuncture, gentle exercise, or meditation can be very effective.

Not only that, it’s possible that opioids are over-kill, providing much more power than is actually needed to keep pain managed during that initial healing period. 

In general, no approach to back pain is the be-all, end-all solution. Instead, the AHRQ tells us that each individual spine treatment tends to yield small or at best moderate effects. A good strategy, and one used by many practitioners, is to combine small and moderate effect treatments together to get their cumulative effect.

The AHRQ adds that most of the time, positive effects from back pain treatments can be had in the short term only. They also say that these treatments work better for pain than for restoring your physical functioning. For this reason taking an active approach—without over-doing it—may be the most effective way to keep back pain away as you go forward in life.

Sources:

AHRQ. Noninvasive Treatments for Low Back Pain. Agency for Healthcare Research and Quality website. Feb. 2016. Accessed: June 2016. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=2192

Linder R, Horenkamp-Sonntag D., Engel S., Schneider U., Verheyen F. Quality Assurance using routine data: Overdiagnosis by radiological imaging for back pain. Dtsch Med Wochenschr. May 2016. Accessed: June 2016. http://www.ncbi.nlm.nih.gov/pubmed/27176071

Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, Holly L, Hunt CH, Jagadeesan BD, Kennedy TA, O'Toole JE, Perlmutter JS, Policeni B, Rosenow JM, Shroeder JW, Whitehead MT, Cornelius RS, Corey AS, Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® low back pain. Reston (VA): American College of Radiology (ACR); 2015. 12 p. [30 references]

Shaheed C, Maher C, Williams K, et al. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain. JAMA Internal Medicine. May 2016. Accessed: June 2016. http://archinte.jamanetwork.com/article.aspx?articleid=2522397

Volkow N, McLellan T. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. N Engl J Med. 2016. http://www.nejm.org/doi/full/10.1056/NEJMra1507771#t=article

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