Persistent Back Pain and Back Surgery

For persistent back pain or pain that becomes increasingly severe over a week or two despite conservative home treatment, consult a doctor to rule out other health conditions that might cause it: kidney disease, bowel or bladder problems, gynecological problems in women, prostate problems in men, neurological disorders, or rarely, tumors (fewer than 1 percent of cases ).

Your exam should include a history and physical examination, but not x-rays unless your doctor suspects that your pain is caused by some disease. “There’s no reason for back x-rays unless the physician suspects a [non-back-related] cause,” Dr. Kuritzky says. “In fact, for most low-back pain, x-rays should be discouraged, especially in women. Women’s reproductive organs cannot be shielded during lower-back x-rays. They receive a substantial dose of radiation.” Similarly, MRIs are also usually unnecessary, not to mention that they show back abnormalities in most people who don’t have back pain.

A decade ago, doctors prescribed pain medication (often for long periods), extended bedrest, and for chronic back pain, surgery. Today, that’s all changed. Nowadays, they recommend ice, pain medication for a day or two, no more than two days of bedrest, and getting back on your feet and returing to normal activities as quickly as possible, along with the home treatments discussed above, and regular exercise, particularly stretches and back strengthening exercises.

Back surgery is necessary in only 1 percent of cases, Dr. Shiple says. If your doctor recommends surgery, do not rush into it. Get several opinions from a variety of back-care practitioners before consenting. Back surgery is traumatic and requires an extended recovery period. It works best for those who have clear symptoms of nerve root compression—numbness, tingling, or weakness down one side—and doesn’t do much for anyone else.