At some point in our lives, 80 per cent of all of us living in the West will suffer from disabling low back pain. Every year, 12 million Americans make new-patient visits to their doctor for chronic low back problems and 100 million patient visits are made to chiropractors. Indeed, more work days are lost from low back pain than any other form of disability in the US and the UK, and the number of working days lost has doubled every decade, currently standing at 60 million in the UK alone. This places back pain squarely in the number one slot as the most common cause of disability after cardiovascular disease.
Low back pain has been called the 'Cinderella' of medicine and with good cause. In most cases, medicine itself has shown a shocking ineptitude in diagnosing and treating back problems, often tending to make the problem worse. This terrible batting average has led a Canadian government report, which studied the available evidence to date, to conclude: 'Many medical therapies are of questionable validity or are clearly inadequate.'
In a scathing article published in 1990 by the International Society for the Study of the Lumbar Spine, Professor Gordon Waddell, orthopaedic surgeon at Glasgow's Western Infirmary summed up this appalling track record: '. . . dramatic surgical successes, unfortunately, apply to only some 1 per cent of patients with low back disorders. Our failure is in the remaining 99 per cent of patients with simple backache, for whom, despite new investigations and all our treatments, the problem has become progressively worse.' (The Lumbar Spine, James Weinstein and Sam Wiesel, eds., WB Saunders Co, Philadelphia, 1990.)
For back patients who undergo surgery, 15 to 20 per cent will fall into the category of 'the failed back' - the official nomenclature for people with chronic, considerable back pain that doctors can't fix. Some 200,000 to 400,000 patients go under the knife in the US every year. That translates into 30,000 people who will emerge from back surgery every year in considerably more pain than they were before they went to their doctor.
A special WDDTY review of the current literature about back treatment reveals that medicine has three ways of making things worse: dangerous diagnostics; inappropriate, unproven treatment and surgery; and poorly studied regional anaesthesia, often, ironically, used to relieve the pain.
In the main, back pain treatments are faddish, adopted in a flurry of enthusiasm and soon discarded in favour of the next new possibility when evidence proves they don't work.
An editorial in the New England Journal of Medicine (3 October 1991) says that earlier in this century, sacroiliac joint disease was believed the culprit in many cases of back pain, leading to fusions (the joining of one vertebra to another) of sacroiliac joints.
This was followed by treatments including the removal of the coccyx, injections for herniated or slipped discs (in which the cushiony centre of the disc, which softens the shock of spinal movement, protrudes out of the fibrous outside), lengthy bedrest, traction and even transcutaneous electrical nerve stimulation. The latest fad to be discredited in that same issue of the journal is steroid injections in the facet joints (the cartilage covering of the bony junction of two vertebrae), showing that injecting steroids is no better than injecting saline.
General practitioners, back specialists and orthopaedic surgeons have demonstrated that many haven't a clue as to what exactly causes most back conditions. In a general review of low back pain (BMJ, 3 April 1993), Andrew Frank, consultant physician in rheumatology and rehabilitation at Northwick Park Hospital in Harrow, England, concluded: 'Up to 85 per cent of patients with low back pain cannot be given a definitive diagnosis because of the poor associations between symptoms, signs, imaging results and pathological findings.'