By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

HUSBAND NEEDS TO SEE DOCTOR TO DETERMINE CAUSE OF LOW BACK PAIN

Question: My husband has been complaining that his lower back hurts for a couple of months now. It seems to come and go, and never get too severe. It doesn’t go down his legs, just stays in one spot in his back. He lifted something heavy several years ago and had a back injury then that bothered him for a couple of weeks. He doesn’t remember hurting himself again, but he is an active guy.

Answer: Low back pain is one of the more common medical complaints that cause people to seek medical care. Low back pain can be mild and self-limiting, but it can also be a sign of a major medical problem. Most adults have at least one episode of low back pain in their lifetime.

Acute low back pain can last for a few days to several weeks. Usually this is a problem with the one or more musculoskeletal structures in the back, which include the muscles, ligaments, bones, and cartilage. The pain -- often a result of some sort of injury or strain to the back -- can be mild to severe. It usually resolves with rest, over-the-counter anti-inflammatory drugs and gentle exercise.

On the other hand, if your back pain persists for more than three months, it’s classified as a chronic rather than acute condition. Chronic low back pain can also range in intensity from mild to severe. While it is not necessarily associated with a major medical condition, its cause can be difficult to determine and it can be difficult to treat.

Since this pain has been going on for a couple of months, a visit to the doctor is probably in order. The doctor will take a history and do a physical exam, then determine if further testing is needed or what treatment is indicated. Many physicians will want X-rays to look for structural problems, and sometimes, advanced imaging such as a CT or MRI of the troublesome area. If the back pain is associated with constitutional symptoms such as fever, malaise, nausea, or weight loss, the physician may look for an underlying medical cause of the chronic low back pain.

If the tests all come out negative and a major underlying medical problem is rule out, treatment with anti-inflammatories, ice or heat, physical therapy and osteopathic manipulative (OMT) treatment may all be indicated. Also, I advise that you encourage your husband to avoid activities that might reinjure or restrain his back.

Since I am an osteopathic physician, I would like to tell you a little more about OMT. I think that a study in the New England Journal of Medicine several years ago was particularly instructive. Researchers studied more than 150 people who said they had been having low back pain for three weeks to six months. About half of them were given OMT, while the other half relied on more traditional treatments such as pain medicine and physical therapy.

Twelve weeks later, the people who had undergone OMT had improved just as much -- and were just as satisfied with their treatment -- as those who relied on medication and physical therapy. However, because they used fewer medications, people in the OMT group had less risk of side effects. Another plus for OMT was that the cost of treatment was lower because the OMT group didn’t need as much medication or physical therapy.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.