The Best Ways To Treat Back Pain

If you suffer from chronic back pain, which is more effective: a long-term treatment or surgery?

The Early Show's Dr. Emily Senay has reviewed the results of two studies printed in the current New England Journal of Medicine. The studies examined two very different types of back problems and the effect of surgical and non-surgical treatment.

The first study looked at treatments for sciatica, a painful condition most commonly caused by a herniated disk; the other painful ailment was degenerative spondylolisthesis, where one vertebra slips forward relative to the one below it. That condition generally strikes after age 50, and affects six times as many women as men.

According to Dr. Senay, sciatica is pain that runs along the sciatic nerve, a very long nerve that extends from the lower back through the buttocks and thigh and down into each leg.

"Several structural problems in the lower back can cause sciatica by putting pressure on that very large nerve," she said. "So can pregnancy, or trauma from an accident. For some people, sciatica causes sporadic discomfort. For others, the pain can be constant, and debilitating."

When surgery was compared with non-surgical treatment of sciatica, the outcomes after one year's time were almost identical. One interesting note: the patients who had an operation endured considerable post-surgical discomfort but after that they tended to improve rapidly, said Dr. Senay. Those who didn't have surgery had a much longer wait for the sciatica pain to recede, so there was a price to pay in time and pain for not getting surgery.

But for degenerative spondylolisthesis, the study indicates that surgery is generally a superior option.

"This condition can compress the spinal canal, and also lead to pain in the legs," explained Dr. Senay. "For this condition, researchers found that surgery tended to be superior to other treatments. Their conclusion was that if the array of symptoms that define this condition are present, surgery is probably preferred — though they did find that delaying or avoiding surgery didn't cause any harm. So patients could take their time and explore options, with no pressure ... other than the pain ... to move quickly," she said. An estimated 40,000 patients a year opt for this surgery.

While the information on these two ailments is useful to those who suffer from them, there is little to be inferred for patients who have other back ailments.

"The results of these new studies are valuable for people with the two conditions we've discussed," said Dr. Senay, "but the conclusions may be quite different for people with other conditions involving the back. And regardless of the back problem that afflicts you ... a detailed talk with your doctor is a must about the pros and cons of the treatments you're considering."