Back Pain

Why did my doctor suggest cognitive behavioral therapy to treat my chronic back pain?

DEAR DOCTOR K: My doctor suggested cognitive behavioral therapy to treat my chronic back pain. Does he think I'm imagining my discomfort?

DEAR READER: I'm often asked this question about cognitive behavioral therapy (CBT). Because it was developed by a psychiatrist and involves "talk therapy," people assume that it is used to treat just psychological problems.

Does acetaminophen help relieve back pain?

DEAR DOCTOR K: I have frequent back pain. I usually take acetaminophen (the Tylenol brand), but I hear it may not be effective for back pain. Is there anything to that?

DEAR READER: If you'd asked me that question even a year ago, I would have said, "Acetaminophen works fine for most people." Lots of people are bothered by back pain. When it strikes, all you want is relief -- and fast. Many folks turn to over-the-counter pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen and aspirin).

What will help relieve my neck pain?

DEAR DOCTOR K: What treatments -- besides drugs or surgery -- will help to relieve my neck pain?

DEAR READER: Neck pain affects almost everyone at some time. Besides the physical discomfort, neck pain can trigger headaches and cause numbness, tingling or weakness in your arms. You may have trouble sleeping and difficulty turning your head.

Are epidural injections effective for treating sciatica pain?

DEAR DOCTOR K: I suffer from sciatica, which has caused a lot of pain over the past six month. My doctor has recommended epidural injections, but I hear that they have been disproven. Can you help me sort this out?

DEAR READER: Here's an answer I'm sure you'll find satisfying: It depends! It depends on what's causing the sciatica, and on which studies you believe.

Can exercise help prevent back pain?

DEAR DOCTOR K: I get back pain every so often. It can last a week and interferes with my life. Can exercises prevent more attacks in the future?

DEAR READER: Absolutely yes -- IF you do them regularly. Exercise is a great way to prevent repeat episodes of low back pain. The right exercise program will help you build strong, flexible muscles that will be less prone to injury.

Can massage therapy help to relieve a sore back?

DEAR DOCTOR K: My back is always sore. A friend suggested that massage therapy might help. Massages are expensive, so I want to make sure there's some evidence behind this. Is there?

DEAR READER: Massage used to be considered an indulgence. But it's now recognized as a legitimate therapy for some painful conditions -- including back pain.

I hurt my back, how soon can I return to my normal activities?

DEAR DOCTOR K: I hurt my back a few weeks ago. I'm feeling better now, but not 100 percent. How quickly should I return to normal activities? I don't want to reinjure my back.

DEAR READER: You're wise to be cautious. After an episode of back pain, it's essential to properly time your return to normal activities. Too rapid a return could lead to a relapse. But -- and this is an important "but" -- too timid a return can delay, or even prevent, recovery. It used to be that doctors recommended immobility and bed rest for people with a sudden back injury that was causing a lot of pain.

Is surgery my best option for spinal stenosis?

DEAR DOCTOR K: I have painful spinal stenosis in my lower back. My doctor wants me to have surgery, but that seems extreme. Is surgery really my best option?

DEAR READER: Lumbar (low back) spinal stenosis is a common problem, particularly in older people. Spinal stenosis is a condition that affects the bones of the spine -- the vertebrae. The vertebrae are stacked on top of each other like a roll of dimes. Each of the vertebrae has a hole in the center of it, the spinal canal, through which the spinal cord travels. The spinal cord carries the nerves that connect the brain to the rest of the body.

What is the most effective NSAID for back pain?

DEAR DOCTOR K: I have frequent back pain. I usually take acetaminophen (the Tylenol brand), but I hear it may not be effective for back pain. Is there anything to that?

DEAR READER: If you'd asked me that question even a year ago, I would have said, "Acetaminophen works fine for most people." Lots of people are bothered by back pain. When it strikes, all you want is relief -- and fast. Many folks turn to over-the-counter pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen and aspirin).

What are the surgical options for a herniated disk?

DEAR DOCTOR K: I have a herniated disk that's been bothering me for more than a year. I've tried exercise, medication and complementary therapies. None have helped. What are my surgical options?

DEAR READER: Let's start with a brief anatomy lesson. The human spine consists of a column of interlocking bones called vertebrae. They surround and protect the spinal cord. Vertebrae are stacked on top of each other. In between each pair of vertebrae is a little shock-absorbing cushion called an intervertebral disk. Intervertebral disks -- think of miniature jelly doughnuts -- prevent the vertebrae from scraping against each other. A normal disk has a jelly-like center (the nucleus) and a tough outer covering.