Do You Really Need Back Surgery?

By Richard Asa  @RickAsa
April 20, 2015

If you have back pain, put off back surgery. Your treatment options should first include remedies such as exercise, chiropractic, acupuncture, and bodywork.

Don’t take the title personally. In “Back Pain Remedies for Dummies,” authors Michael Sinel, MD, and William Deardorff stake their claim very quickly: “We believe back pain is completely manageable and that surgery is avoidable in the vast majority of cases.”

That statement alone should bring some relief if you are one of more than 50 million Americans who have back pain. Here’s another soother: About 5 percent of patients with back pain need surgery, asserts Charles Rosen, MD, clinical professor or orthopedic surgery at the University of California-Irvine.

That begs the question of what you can do for your back pain instead. The simplest answer is: a lot. (And less treatment is more, research is showing.)

Surgeon Patrick Roth, MD, advocates an approach of “education and progressive exercise,” for example. “Back pain requires a deliberate, intentional, and plodding fix. The slower fix looks to build back health rather than eliminate pain, and this leads to a reduction in back pain.” He, too, believes “surgery rarely fixes back pain.”

Roth’s approach falls under the broad category of learning physiological techniques and gaining an understanding of your back pain in order to prevent it.

In their practice, Sinel and Deardorff employ what they call a “whole-person, multidisciplinary approach.” That means, in large part, they are open-minded and fit the treatment to the individual.

They include medical approaches, exercise, chiropractic, acupuncture, and bodywork. They also work with you to build a library of self-help techniques that can include aerobics, nerve blocks, medication, guided imagery, and yoga, for example. Just as importantly, they spend time with you to dig into possible emotional roots of your pain, which psychologists will tell you is not far out at all.

They acknowledge that finding the right treatment for your back pain can be frustrating. “Everybody seems to have an opinion about what you should do,” they write. “Your mother-in-law swears by her chiropractor, your son thinks you should try yoga, your boss touts physical therapy, and your best friend raves about the results of his surgery.”

None of them are wrong, especially if what they recommend has worked for them. But what has worked … worked for them. Sinel and Deardorff would only hope that each person got their relief from back pain systematically, rather than by coincidence. Picking a certain treatment by yourself is like gambling, and casinos make a huge profit for a reason. Most of the time, you lose.

The first thing to do, then, is find the right person, probably a doctor, who can be the quarterback of your treatment regimen and help coordinate what gets done when. That will take some time and homework. You want a face-to-face consultation .

Sinel and Deardorff want you to know that the timing and integration of treatment options, traditional or non-traditional, “is the key for you to successfully overcome your back problem.” For you, that might mean physical therapy in combination with an exercise program and acupuncture “if you receive all these treatments in a specific, overlapping time frame.”

In any case, get a second opinion, or even a third. You need to feel comfortable with what you agree to do. Speak to   study practitioners of both traditional and nontraditional treatments to understand how they might treat your back pain, and whether they would work with others.

Multidisciplinary approaches may be your best bet because they have high success rates. The Texas Back Institute’s CoPE (Conquering Pain Effectively) program is a good example. Patients “boost their mobility by 50 percent, on average, while cutting their pain in half and their painkiller use by 75 percent,” according to a widely circulated article in Good Housekeeping.

The article recommends that if you want to enter a pain program, make sure it’s certified by CARF (the Commission on Accreditation of Rehabilitation Facilities).

There are myriad ways to approach relief of your acute or chronic back pain. The key is to make thoughtful choices based on your own research, rather than impulsive choices that may be driven by the agony you’re in. The treatments you find acceptable need to be linked and coordinated. Otherwise, it’s like building an erector set with pieces missing. It won’t work.

Move from the most conservative, non-invasive approaches to more intensive treatment if you don’t get relief.  But, always try to remain conservative.

Remember that the obvious often isn’t obvious. That includes ice application, heat therapy, and standing at intervals throughout the work day instead of sitting all day, according to Spine-health.

A massage from an experienced, skilled therapist can alleviate pain from a pulled muscle. Over time, Spine-health says, regular stretching exercises and modifying your activity can help prevent bouts of pain. You can learn these techniques through an experienced physical therapist.

Sometimes it’s all about the simple things in life. That applies to your back as well.


March 27, 2020

Reviewed By:  

Christopher Nystuen, MD, MBA