San Francisco -- As back pain has become an increasingly common
ailment in the United States -- and for chronic sufferers, one of
the most debilitating -- desperate patients and their doctors have
propelled major advancements in the field.
New treatments range from the cheap and easy -- yoga and
acupuncture, for example -- to expensive and invasive procedures
like disk replacement surgery or injecting quick-drying cement into
the back to help stabilize the spine.
Now, many spine care experts say after years of progress, it's
time to take a step back and re-evaluate the recent so-called
advancements.
The cost-effectiveness of these treatments will be a major topic
of discussion in San Francisco this week when thousands of back
care experts are expected to flood the city for one of the world's
largest conferences on the spine.
"Five years ago, the topics would be on all the new technology:
look at this new thing we've come up with, and isn't it great? But
the current environment has pushed that to the back seat," said
Dr. Charles Branch , president of the North American Spine Society
, which is hosting this week's conference. "Now it's, let's take
the stuff we're doing that we think works, and prove it to
everybody."
The conference will run Tuesday through Saturday at the Moscone
Center . Nearly 3,000 spinal care experts -- including surgeons,
physical therapists, chiropractors and nurses -- are expected to
attend.
Roughly four in five Americans suffer some sort of back pain,
doctors say, and it's the third most common reason for people to
visit their physician. Part of the reason back pain is so common is
because the fairly narrow spine is expected to support a great deal
of weight. That means as Americans have gotten larger, so has the
field of back care medicine.
The past 15 years have seen major advancements in spinal care,
much of it expensive and invasive. Doctors seem to agree that most
recent treatments are useful -- the questions are how useful, and
to whom are they useful.
"These patients are in a lot of pain, but at the end of the day
you've got to be honest and make sure what you're doing makes a
difference," said Dr. Patrick Suen , chief of regional spine
surgery at Kaiser Permanente San Jose . "It's not that I'm saying
all these technologies don't work. There probably is a use for all
of them, but it's not for everybody."
For example, disk replacement surgery is typically done for
people who have degenerative disk disease, and for whom other, less
invasive treatments haven't been successful. But not everyone will
see improvement with the procedure -- at all.
For others, the surgery might help for a few months, but then
the pain comes back, which raises the controversial issue of
cost-effectiveness. Disk replacement surgery can cost tens of
thousands of dollars.
"For patients who have back problems, the compromise on their
quality of life can be very severe," said Dr. Serena Hu , an
orthopedic surgeon and chief of spine service at the University of
California at San Francisco. "Some patients, what you can give
them may be worth the cost. But nobody wants to treat a patient
with an expensive procedure and have it only last three months."
For a while in the 1990s, surgery for back pain seemed like a
good catch-all answer for most patients. But spine care experts,
including surgeons, have since backed off that solution, and now
most agree that patients need to be evaluated carefully, especially
before starting invasive treatments.
In fact, most people who experience back pain won't be helped by
surgery at all, said Harley Goldberg , director of the spine care
program at Kaiser Permanente San Jose . Research into dozens of
areas of non-invasive treatments -- including yoga, acupuncture and
massage -- have produced sometimes mixed results. But when he sees
patients, he almost always recommends they start simple, with basic
stretching and strengthening exercises and ultimately regular
workouts.
"My caution to most people with back pain is to stay simple.
Exercise regularly and find a specific exercise program that works
for you," Goldberg said. "It's only when it's more severe,
unrelenting pain that we require the more aggressive, invasive and
sometimes surgical answer."
c.2009 San Francisco Chronicle