This is the second installment in a two-column series dealing with the importance of proper back care while enjoying a wellness lifestyle in recovery. The first column provided an overview concerning the relevance of back care to people suffering from substance abuse disorders, together with basic pointers for preventing lower back problems. This column focuses on basic treatment and rehabilitation considerations for chronic back pain, again with an emphasis on the importance of these considerations for people in recovery.

First, let’s highlight basic first aid measures to employ when we experience an acute episode of back pain. Immediate application of ice to the injured area is generally recommended. If the pain persists for several hours, alternating between applying ice and heat is often very helpful. And of course, we should immediately cease whatever activity we were doing that may have triggered the acute episode of pain. Extremely painful or debilitating back pain requires immediate medical evaluation.

When should you seek assessment and treatment for a back problem? Oftentimes an episode of back pain will clear up on its own within 10 days or so. During this time, you can continue your usual physical exercise routine and other activities, while avoiding movements that place a strain on the injured back muscles.

If the pain persists or becomes worse during this period, it is probably time to seek out professional evaluation and treatment. Above all else, do not take prescribed pain medication on your own or begin increasing the dosage of over-the-counter medications. Also, resist the urge to self-medicate by drinking or turning to other drugs. Abuse of pain medication is the fastest growing form of addiction. For those of us in recovery this is an easy trap in which to fall. Experimenting with selfmedication can also trigger a relapse to our former drug(s) of choice.

If the severity and chronicity of your back pain reaches the point where professional evaluation appears advisable, it is helpful to have a general awareness about what to expect from the various treatment options available.

Conventional Medical Treatment

 Under the prevailing medical model, chronic back pain is often viewed as emanating from structural abnormalities, such as a ruptured or deteriorated disc. If you visit a medical doctor for evaluation, you will indeed be fortunate if he or she recommends specific exercises to strengthen the muscles surrounding your lower back, together with exercises or other modalities to promote increased flexibility.

Many times, however, a medical professional will immediately prescribe a combination of muscle relaxants and pain medication, which often carry with them a high potential for dependency and addiction. If these medications fail to alleviate the problem, the next step is often to administer steroids, either orally or by injection. Prolonged oral administration of steroids places the various bodily systems at risk of serious side effects.

In the case of persistent back pain, an MRI or other high-resolution imaging procedure is often ordered, followed by referral to an orthopedist for further evaluation. The orthopedist will often point to structural problems involving one or more discs and recommend back surgery, a highly complex and expensive surgical procedure that should not, in my opinion, be entered into without fully exploring other available options.

While back surgery may be indicated in rare situations, a growing body of medical research suggests that the majority of the 500,000-plus disc surgeries performed annually may be both unnecessary and ineffective. According to a 1994 report issued by the U.S. Public Health Service Division of Health Care Policy and Research, “[Back] surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems.” (Smith, 2011)

Alternative Approaches

Several years ago, while struggling with severe back, neck and shoulder pain, I came across a book by Ronald Siegel, Michael Urdang and Douglas Johnson, titled Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain (2001), which I continue to find extremely helpful. The following description of a holistic, alternative rehabilitative approach draws mainly from this book, mixed with some observations of my own. The approach advocated by Siegel and his associates entails a full recognition of the deep mind/body connection in health and healing. The authors’ make the observation that chronic back problems can generally be traced to a prolonged period of accumulated, unresolved stress and relative inactivity, which definitely rings true in my case. Their assertion that chronic back pain is usually due primarily to chronic muscular tension rather than structural abnormalities also hits home with me.

All too often, the authors contend, the treating physician or other health professional unwittingly reinforces a negative mind-set on the part of the patient. This is triggered by emphasizing the alleged structural damage to the back and advocating rest and restriction of activity. The resulting perception of hopelessness and helplessness locks the patient into a vicious circle of escalating back pain, while convincing the patient to give up exercise and cut back on other physical activity out of fear that these activities will make the problem worse.

An important cornerstone of Siegel’s rehabilitation model entails helping the patient reverse this negative cycle by changing his or her mind-set to one of empowerment. This empowerment mind-set involves taking charge of one’s health with full confidence that he or she can learn to return to his or her former range of activities without experiencing debilitating pain.

Siegel’s rehabilitation model also emphasizes reducing tension in the muscles surrounding the back via massage, relaxation exercises, yoga, guided imagery and possibly cognitive/behavioral psychotherapy. This goes hand in hand with encouraging patients to become progressively physically active and engage in a supervised exercise regimen designed to promote overall muscular strengthening and flexibility, particularly in regard to the muscles supporting the back.

Based on my own experience, I would also advise patients to actively explore the potential benefits associated with chiropractic manipulation. Particularly as we grow older, I believe that many of us develop back problems associated with chronic muscular tension, accompanied by cumulative structural abnormalities that exacerbate the cycle of tension and pain. I am currently undergoing, with very satisfactory results, a course of chiropractic treatment for sciatica (a pinched nerve condition) that entails a completely natural, nonsurgical, drug-free approach.

In summary, chronic back pain requires skillful evaluation and treatment. In exploring available options, patients should be aware that treatment approaches entailing excessive reliance on medication and/or surgery might end up doing more harm than good while concurrently exposing people in recovery to heightened risk of relapse and/or cross-addiction. Accordingly, I would advise patients suffering from chronic back pain to also explore more holistic, natural (and substantially less expensive) treatment options such as those discussed in this column.

Dr. John Newport is an addiction specialist, author and speaker living in Tucson, Arizona. He is the author of The Wellness-Recovery Connection: Charting Your Pathway to Optimal Health While Recovering from Alcoholism and Drug Addiction, and most recently he released, The Tucson Tragedy: Lessons from the Senseless Shooting of Gabrielle Giffords. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

Siegel, R. D., Urdang, M. H., & Johnson, D. R. (2001). Back sense: A revolutionary approach to halting the cycle of chronic back pain. New York: Broadway Books.

Smith, J. C. (2011, June). Back surgery: Too many, too costly, and too ineffective.” Toyourhealth.com.

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