Back to basics

there are certain ailments that are not universal and some that invariably strike irrespective of whether it is a man or a woman, working, self-employed or even a housewife. Back pain is one such complaint that is increasingly topping the list of serious urban health problems. There is enough epidemiological data to show that as many as 85 per cent of all adults have back pain at some point of time in their life. Health experts estimate that at any given time, about 30 per cent of the patients visiting doctors complain of backache.

In the us, back pain is the most common cause of activity limitation among productive people (below the age of 45), and ranks as the second-most common reasons for visits to the physician, the fifth-ranking cause of admission to hospitals and third common cause of surgical procedures. The estimated health costs are also staggering: a hefty us $30 to us $70 billion per year. In the uk and rest of Europe, besides being the single-largest cause of absence from work, bad back is the reason given for about 15 per cent of all sick leaves.

Not surprisingly, back pain is receiving serious attention -- both in respect of correct diagnosis to treatment procedures. A study published by a Dutch group shows that bedrest, normally advised for patients with back pain, may not really be needed.

A team of researchers headed by P Vroomen of the department of Neurology, Maastricht University hospital, the Netherlands, studied 183 patients with back pain and randomly divided them into two groups. Half the patients were instructed to remain in bed for two weeks, while the second half were asked to go on with their normal life (watchful waiting group). The groups were well-matched for age and sex, as well for the duration and severity of the pain. The control (normal activity) group had significantly more serious symptoms. Both groups were allowed similar medication like pain killers and anti-inflammatory drugs.

After two weeks, 64 of the 92 patients (70 per cent) in the bedrest group reported improvement, as compared with 59 of 91 (65 per cent ) in the watchful waiting group. After 12 weeks, 87 per cent of the patients in both groups reported improvement. The authors concluded that the majority of patients improve with watchful waiting and that a two-week period of bedrest does not lead to a more rapid or complete recovery ( The New England Journal of Medicine, Vol 340, No 6).

There is another study being conducted by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, usa, to find answers to one of the long-standing debates: whether patients with back pain benefit more from surgical or non-surgical procedures. Over 1,450 patients who have back pain due to herniated lumbar disk, spinal stenosis or degenerative spondylolisthesis have been randomly assigned to surgical or non-surgical treatment. Non-surgical treatment includes treatment according to the severity of the patient's condition such as bedrest, oral drugs of various kinds and other therapies. This study is still underway ( The Journal of American Medical Association, Vol 282, No 15).

Backache, nevertheless, remains a thorny problem for patients and physicians alike, the issues complicated by the confusing advice given by physicians. Doctors are still in the dark as there are still several basic issues that are not clear, such as the level of activity in patients, amount of bedrest needed and the mode of treatment. But the ongoing research towards a combination of high-tech methods of diagnosis coupled with the traditional methods of treatment should soon help millions of backache patients get back to work places.