Deciding what to do about low back pain is getting infinitely more difficult with every therapy technique, surgical procedure and postural device created. Every treatment option available is great in its own right, but that doesn't necessarily make it right for you.
And I cannot even count how many people assume they have the exact same problem as their neighbor or dad because "they have the same kind of pains". Lots of back pains are similar feeling! It absolutely does NOT mean you should self-diagnose! But you want to feel better, to spend as little as possible doing so, and hopefully keep your sanity along the way. So here's my advice to all of you dealing with low back pain.
Saving your back requires 2 things:
- A good diagnosis
- A good and appropriate therapy.
A good diagnosis is tricky because as much as our knowledge about the back and how to treat it has increased, bodies are complex and inexact. Surgeons won't be replaced by machines because there are too many intricate differences in anatomy and body reactions.
Different specialists will give you different opinions based on their specialty knowledge and experience, so when seeking advice you should consider at least 2 diagnoses. Until you truly know what's wrong, you can't choose a therapy to help heal yourself properly.
You may also be tempted to get expensive testing to be "sure" the right diagnosis is made. I've had tons of people ask me if they need an MRI for simple back pain. While the detail is exquisite on an MRI, it's rarely necessary. And even if there is something abnormal on your films, there is no guarantee that the abnormality is the cause of your pain.
In 1994 the highest respected medical publication, the New England Journal of Medicine, showed that when M.D.'s read low back MRI's of 98 people with NO PAIN that over half of them were diagnosed as having "serious problems"-mostly with their discs.
In an effort to guide doctors better, the NEJM released a newer study reporting that doctors should only use imaging for a suspicion of cancer, infection, or for a persistent neurological deficit (meaning long-term loss of sensation and/or function).
Instead of relying on high-tech diagnostics, see several practitioners and weigh their diagnoses. Once you know what's going on, only then can you decide who can help treat you. When making therapy decisions, start out conservative and ask for several referrals of people that might help you. Lightly research their methods of treatment and then decide who will best fit your problem with their care strategy.
Saving money requires:
- Getting a 2nd opinion
- Asking questions and researching diagnoses and responses
It might seem counterintuitive, but to save money you need to get at least 2 opinions. You don't buy the first car you test drive and pay full price without shopping around. So don't buy into the first diagnosis and therapy option.
I recently had a friend in San Diego seek out a D.C. for back pain. After being told he could be "fixed" for $1500.00 he was encouraged by me and another friend to try a D.C. that treated pro sports players before committing to the first doc. The pro sports D.C. examined him, gave one treatment, prescribed exercises and a treatment plan of a few simple visits followed by a closing evaluation.
Although the first doc had a great explanation and sales pitch for care, the second doc was just as qualified (if not more so) to treat the sports-oriented injury. The second doc's recommendation was a significantly smaller plan which equated to about $1000.00 in savings. Even with spending the extra money up front to see 2 docs, my friend saved money overall.
The second part of saving money involves asking questions and researching the diagnosis and answers you are given. Doing your own research based on random internet sites for "back pain" and advice from friends is one of the worst things you can do before getting a professional opinion because you will fixate on details and others' experiences rather than your own.
For example, cancer will be one of the diagnoses you encounter if you search for "night time pain" listed as a symptom. Unfortunately, nearly every lower back pain disorder can also cause night pain. Fixating on symptoms can give you a false sense of what your diagnosis should be.
The time to research the heck out of what is going on with you is after you get two opinions. Doctors are not infallible and as mentioned before, medicine is still an art as much as a science. So before you buy into any one diagnosis or treatment plan, do your research and see if what they say fits with how you feel.
It's much easier to Google a specific injury like "lumbar sprain" and get excellent advice on care than a generic "back pain". In the case of many of my patients asking questions has saved them invasive tests and expensive surgeries.
Saving your sanity starts with:
- Simplifying the terms
- Listening to your gut
Once you've compiled all this info, you have to be careful not to drive yourself and your doctor insane with making a decision. Read a bit about the problem, a few explanations about treatment and a few testimonials from people that have tried the therapy. Then you must simplify the issue.
- Is there numbness, tingling or weakness (this indicates a more serious problem than pain alone because it means that you have nerves that are so compressed they are on their way to dying)
- Is it getting better, worse, or staying the same (if it's getting worse-you have less time for conservative care and need someone watching your progress closely)
- Is it just muscle and joint issues (if it's just muscle and joint you can start with massage, physical therapy, chiropractic and acupuncture!)
- If invasive treatment like surgery can be avoided for awhile be aware of what change in symptoms would signal in increase in risk and would mean you needed to do more than conservative care (for example, if numbness gets worse you need to know what level is nearing the dangerous point-of-no-return nerve death)
If invasive treatment is recommended (like surgery), you need to know:
- what are the risks (can you die, get long-term paralysis, etc.)
- what are possible long-term problems (is the surgery going to make you likely to develop arthritis. Will you need a second surgery later and how soon)
- what are the statistics (how many people that have the procedure are actually better off? Are they better off long-term aka 10 years down the road?)
If you can try a conservative treatment, do it! Try combining therapies as well. Mixing physical therapy, chiropractic, massage, acupuncture, yoga, etc. will give your body move help in stabilizing and you wont plateau as quickly.
Lastly, before you decide and you have compiled the information and statistics necessary to decide "reasonably", listen to your gut instinct. Neuroscientists have shown that your "gut" is actually your subconscious brain giving you information needed in the decision-making process.
You may consciously read a ton of articles, but subconsciously your brain is gathering far more data than you can possibly pay attention to. So pay attention to your emotional "gut reaction" because it is just as valid as your overriding "reasonable" brain.
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