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U.S. must change approach to treat back pain effectively

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Among developed nations, back pain causes the greatest burden of disability. In the United States it gives families, employers, carriers and taxpayers alike a pain in the backside. Enhanced awareness, and an emphasis on prevention and low-tech, cost-effective integrative treatment, will improve quality of life and the bottom line for all considered.

Medical advances in the treatment of cardiac disease, cancer and myriad other illnesses continue to extend life expectancy, which results in more years and miles being placed on American spines. Considering the fact that the evolution from four-legged movement to walking upright on two legs happened relatively recently, humans spines are still adjusting.

Additional risk factors for back pain in modern society include a sedentary, workstation-bound, display-screen-focused lifestyle on one hand, and the popularity of sports involving high impact or repetitive stress on the other. Americans also spend countless hours doing physical activity that calls for asymmetrical movement such as throwing balls and swinging rackets, bats or golf clubs.

For most physical activities, stretching is viewed as a brief precursor to cardio or strength training. At the end of the day, many sports are enjoyable, engaging and rewarding but hard on the spine. Additional risk factors for back pain include nicotine dependence, obesity, alcohol abuse and depression.

The Centers for Disease Control and Prevention has determined that nearly 1 in 3 U.S. adults reported back pain in the previous three months. It is the leading cause of lost workdays in the U.S., with total costs at $100 billion to $200 billion annually.

Many primary health providers lack training to help prevent and optimally manage back pain, and too often, after a failed, brief course of anti-inflammatory medication and physical therapy, patients end up with an MRI and a surgical referral. Spine surgery is incredibly expensive but indispensable for the right person at the right time. It is also more lucrative than other low-tech treatments. As a result, nonoperative myofascial and musculoskeletal pain often goes untreated or results in a prescription for opiate pain medicines that can result in dependence and addiction.

Caregiving for those with disabilities such as back pain draws huge resources from families and society. In Hawaii, AARP is pressing legislators to enact laws requiring that caregivers be trained to manage patients before hospital discharge. This is wrong. While responsible caregiver training should be given far more attention and become part of discharge planning, hospital discharges should not be held hostage to logistic challenges. The priority must be to free up hospital beds as appropriate, leaving room for new admissions.

Suggestions for preventing and managing back pain:

» Remain active and keep weight in check.

» Remember that it is easier to manage calorie intake than to burn off excess calories.

» Curb excess alcohol and stop smoking.

» Consider low-impact activities that use both sides of the body equally.

» Explore yoga as a way to restore and maintain a healthy, flexible spine.

» While doing cardio and strength work, give at least as much attention to flexibility training, the third critical element to a healthy frame.

» Consider integrative therapies such as physical therapy, occupational therapy, acupuncture and massage therapy for nonoperative back pain.

» Set the goal to be mobile and pain-free for the long run rather than risking injury by obsessing on breaking a personal record.

Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to

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