Back surgery often unnecessary, but may speed pain relief
Most people with chronic back pain will find relief without surgery, but it may speed recovery for some, new research suggests.
An estimated four out of five Canadians will experience back pain at some point in their lives.
A study appearing in Thursday's New England Journal of Medicine compared surgery with the healing power of time for peoplewith severe back pain due to a herniateddisc or sciatica.
With a herniated or slipped disc, the disc that provides cushioning between the vertebrae bulges out, pressing against the sciatic nerve that runs down the leg.
Surgery to remove part of the bulging disc is a common operation that is usually quite successful at relieving the pain that goes down the leg, said Dr. Joel Finkelstein of Sunnybrook Health Sciences Centre in Toronto.
"They'll wake up in the recovery room and the pain will be gone," Finkelstein said. There are complications in about one to two per cent of cases.
Dr. Wilco Peul of the Leiden University Medical Center in the Netherlands looked at 283 patients with sciatica for at least six weeks before the study began. The researchers found that 95 per cent of patients reported recovery after one year, whether or not they had surgery.
About 40 per cent of the participants assigned to conservative wait-and-see care also opted for surgery, which seemed to relieve symptoms more quickly.
"For patients with persistent sciatica, there seems to be a reasonable choice between surgical and nonsurgical treatment, which may be influenced by aversion to surgical risks, the severity of symptoms, and willingness to wait for spontaneous healing," Richard Deyo of the University of Washington in Seattle said in a journal editorial.
Surgery should only be considered an option if the pain has persisted for at least six weeks, said Michele Crites Battie, a physical therapy professor at the University of Alberta who researches back pain. Chances are, the pain will eventually go away on its own.
"If you can manage those symptoms, if you can hang on tight, you have options," said Crites Battie.
Amanda Krischke of Edmonton, who twisted her lower back one month ago, plans to wait it out for now with exercise and physiotherapy to ease the pain.
"I just felt this popping sensation and fire going down my back, going down my leg," recalled Krischke. "I said to myself, 'Oh, I'm going to pay for this for a few days, I can just tell.' "
If the pain lasts months more, Krischke said, she'll consider the faster relief of surgery.