Almost Every One of You Will be Cursed With This ... Low Back Pain! It's Boring as Heck, Except When it Isn't.

Michael Burg, MD

About 80% of you will experience back pain at some point in your lives. The back pain you experience will not be fleeting. It won't be a twinge. It'll hang in there for awhile and make you miserable.

Welcome to the club!

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My back hurts.

That has been the case since a morning, just a regular morning, many weeks ago. The day prior, my usual workout: stretching and sit-ups first, then the stair climber for 20 minutes and the treadmill for another 45. Light weights next, “lat” pulls, curls, triceps extensions, nothing too challenging. No sense pushing it. Mammoth “guns” are not in my future, especially not with a herniated cervical disk.

Afterward, also the usual … shower, spa, and sauna. I went to bed that night feeling fine.

The next morning, definitely NOT fine. An intense low backache — fierce, as though someone had grabbed hard and squeezed — wracked me. The central cramp’s current coursed down my legs, bypassing my thighs, pooling in my leaden calves and feet.

Standing hurt. Sitting hurt too. Kneeling, squatting, lying down, both supine and prone, also hurt. Two extra-strength Tylenol tabs, three aspirins, a hot shower, and rest made no difference. My back hurt before those interventions and just as much after.

I’m an emergency physician in a large teaching hospital, working with physicians-in-training. In every case we see, there’s a teachable moment. It’s my job to find that moment and expound upon it.

But back pain bores every doctor I know. It’s as common as toast and just as dull. Even if I were cloned and became my own physician, even then, my own back pain wouldn’t interest me.

The mechanical equivalent of the common cold is, you guessed it, back pain. With a cold, don’t see a doctor and your symptoms will drag on for an entire week. If you do see a doctor, he’ll cure it … in seven days. Ha! freakin’ Ha! Just what you want, a doctor joke for your sniffles, miserable cough, and aching head.

Likewise, the natural course of most back pain is resolution. Usually, it’s etiology is not worth pursuing because it’s “self-limiting” to use a technical term. It just goes away. Do what you wish (within reason) — gentle activity and stretches, heat or cold, various medications, massage, yoga, meditation, crystals, imagery, curative spirits, voodoo, muscle relaxants, whatever … back pain just fades away, mostly. Relief eventually occurs in 80 to 90 percent of patients regardless of the treatment protocol, offering no challenge or satisfaction for the professional healer, just tedium.

Certain back pain presentations can elevate it from tedious to intriguing. One such fascinating combo is back pain and fever. This pairing may mean that serious, even life-threatening, disease lurks. Maybe it’s just a kidney infection, but other enthralling entities are possible. Back pain in a cancer patient deserves careful consideration. So does back pain with concomitant abdominal pain, leg weakness, symptoms like weight loss, anorexia and fatigue, and bowel or bladder dysfunction. New or worsening back pain in the elderly is also worrisome.

None of this exotic baggage belonged to me. Personally nice, but far from entertaining for my doctor.

I called him for an appointment about six weeks into my ordeal. Everything I’d tried for relief had failed. He reluctantly squeezed me into his maniacal schedule. But even the tone of his voice revealed a profound ennui at having to see me. My personal desperation point had been reached though; I didn’t care if I was boring.

Even without encountering me, my doctor leads a pretty dull existence, so I always try to spice up his day. But during the exam, as he monotonously ran down his standard question list — “How long has it been there? Where does it hurt? What have you tried to make it better? Do you have muscle twitches, weakness, incontinence, blah, blah, blah?” — I gave him nothing electrifying. When he was through poking and prodding, forcing me to jump and bend, and banging on my spine, he sat back and did the “doctor hmm.” I seized that moment to jump in with, “Did I mention my cyclical fevers to 103?”

He nearly toppled from his stool as he whirled around. When I had his undivided attention, I added, “Just kidding.”

Many believe an MRI can diagnose the cause of back pain. This is true in select cases, but false in most. Many back-pain patients have no “imaging” abnormalities to account for their agony. And, many individuals getting CT scans, X-rays and MRIs for reasons other than back pain have hideously disordered backs, chock full of bulging disks and collapsed vertebrae, but … no back pain.

I honestly questioned what I would do with imaging information. If disk herniation was found, would I consent to surgery and postoperative pain added to the discomfort I’ve already endured? Besides, the stats on lumbar disk surgery are grim. Only 50% of patients have sustained relief following surgery; the other half continue to have pain, often worse than it was pre-surgery. But I want the MRI because I want answers. I’m not entirely sure why I do, but I do. I, I, I … it’s all about me at this point.

After some humorless thrust-and-parry with me, my doctor agreed to do the MRI … grudgingly.

“The insurance company will have issues with this,” he grumbled.

I’m sure they will. They will (rightly) question the decision to do an expensive test for a self-limited process; and I don’t care. Maybe, though, they’ll find cancer or some other unexpected treat on the MRI. That’ll be interesting!

I predicted then, and I’d predict the same today, minimal to insignificant MRI findings. Time would (and did) cure my back pain. Boring AF (to use a modern add-on), but it wasn’t then.

Years ago, awaiting my MRI date, I was keenly aware that it had been almost two months since I awoke in pain. My back hurt daily, often worse than it had on day one. But I appreciate why people seek emergency department care for their mind-numbing, almost-always-incredibly-uninteresting, low-back pain.

Desperation takes hold after a while. If the long search for diagnosis, relief, and cure crescendos at 2:00 a.m. on Sunday, they find me and plead for relief and answers.

I understand their anguish now and have for a long time.

(The events in this story were resurrected and reworked from a time in my relative youth. They are as true and relevant today as they were then.)

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San Luis Obispo, CA

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