Do You Really Need Back Surgery?

By Richard Asa and Temma Ehrenfeld @temmaehrenfeld
June 23, 2022
02 Oct 2013 --- Male physiotherapist examining mans back --- Image by © LightWave/Corbis

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

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 the millions of Americans who have back pain. In one survey, 39 percent of American adults said they had back pain within the past three months. Almost everyone will have a problem at some point in their lives.


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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-San Diego.

That begs the question of what you can do for your back pain instead. The simplest answer is: a lot. And less is more may apply to treatment. For example, the National Physicians Alliance has recommended to doctors that they skip imaging for low back pain within the first six weeks unless red flags are present. Why? Imaging leads to unnecessary surgery and has not improved outcomes.

Why do people get back pain?

Only a small group of people with back pain ever turn out to have a clear cause. People with physically demanding jobs, smokers, and obese individuals or people with other health problems are at greatest risk of reporting low back pain.

Most people with new episodes of low back pain recover quickly, but the pain may return and, in some cases, becomes chronic and disabling. Your pain is most likely to persist if it is intense and you have pain in other parts of your body. Pain is in some sense a condition of its own — regardless of the site that is painful.

You’re not alone or rare: Disability from back pain has risen by more than 50 percent around the world since 1990.   

What you can do to treat your back pain

Try applying heat, getting a massage, seeing an acupuncturist, and taking over-the counter NSAIDs.

Avoid opioid painkillers, which are linked to more disability over time.

If your pain persists, the first step may be finding the right person, probably a doctor, who can be the quarterback of your treatment regimen and help coordinate what gets done and when. That will take some time and homework. You want a face-to-face consultation.

Surgeon Patrick Roth, MD, advocates an approach of education and progressive exercise. “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 that 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 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, acupuncture, and bodywork. They also work with you to build a playbook 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,” say Sinel and Deardorff. “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.

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 practitioners of both traditional and nontraditional treatments to understand how they might treat your back pain, and whether they would work with others.

Avoid impulsive choices when you’re in agony. Instead, 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 workday instead of sitting all day.  

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

One popular exercise program for low back pain is Pilates. Two to three sessions a week has been shown to be effective at cutting pain in studies that measured results for up to three months. Sometimes, it’s all about the simple things in life. That applies to your back as well.


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June 23, 2022

Reviewed By:  

Christopher Nystuen, MD, MBA and Janet O'Dell, RN