Can Low Back Pain Be Managed Without Surgery or Drugs?

Laird Harrison

Disclosures

December 07, 2016

In This Article

One Surgeon's 5-Step Process

Ideally, a clinician could offer someone with chronic back pain a range of treatments, including yoga, acupuncture, massage, spinal manipulation, and structured exercise programs, as well as MBSR and CBT, Dr Cherkin says.

But he cautions that offering psychosocial therapies to patients referred for surgery could be problematic if patients feel they are being told, "It's all in your head." Dr Cherkin says he is not aware of studies in which mind/body therapies were used in patients who had prior spinal surgery but who were still in pain.

Dr Hanscom can share his own experience with his patients. He addressed his stress first by following lessons in the book Feeling Good: The New Mood Therapy, by psychiatrist David D. Burns, MD.[7] As the book instructed, Dr Hanscom wrote down his negative thoughts and then categorized them. Gradually, his anxiety diminished.

But recovery wasn't as simple as doing a few writing exercises. "I improved over about 6 weeks and stalled," Dr Hanscom recalls. "I was forced to address my anger issues, and that is when I really noticed a dramatic decrease in my symptoms."

Now when patients come to him with chronic back pain, he investigates to find out whether they have a precise structural indication for surgery, such as a bone spur causing sciatica. If they do, he performs surgery.

But absent such a structural cause of pain, he offers patients a set of resources they can use for getting out of pain:

  • Learn about the causes of your chronic pain;

  • Do expressive writing;

  • Meditate;

  • Get a good night's sleep via a technique such as sleep hygiene—or sometimes medication; and

  • Learn not to share your pain.

"Talking about their pain too much will reinforce 'unpleasant circuits' that develop in the patients' brains wherever their attention is focused," Dr Hanscom says.

Dr Hanscom has codified this approach in a book, Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain. Using this approach, Dr Hanscom has found that he and his colleagues were often able to reduce patients' use of narcotics—or even wean them off altogether.

At least 60 of Dr Hanscom's patients, who were scheduled for spine surgery, canceled their procedures after trying his recommendations. Dr Hanscom is preparing a paper discussing these results.

But he doesn't pretend that he has an easy solution to offer everyone with back or other forms of pain. Pain still crops up in Dr Hanscom's own life—most recently, in the form of an arthritic knee. So far, he has avoided replacing the joint, but it has taken a lot of concentration. "I am still on a learning curve," he says.

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