Environmental Factor, October 2005, National Institute of Environmental Health Sciences
Low Back Pain - What Can I Do About It?
By Blondell Peterson
Tim Carey, a general internist at UNC Chapel Hill and primary care physician, was the guest speaker at the Rodbell auditorium on Sept. 15. His topic was, "Low Back Pain-What Can I Do About It?" The event was sponsored by The NIEHS Fitness and Wellness Program.
Carey moved from the division of general internal medicine to direct the Cecil G. Sheps Center at UNC. He holds a masters degree in public health and epidemiology and is affiliated with multiple training programs, including the Robert Wood Johnson Clinical Scholars Program, the NIH funded Clinical Research Curriculum, the Primary Care Research Fellowship, and the Faculty Development Program in General Internal Medicine.
While completing a training fellowship in epidemiology and health services research at the University of Southern California Carey studied back pain. "It seemed like an interesting intersection of pand society because it seemed to be something that we, as a society, had not done a good job dealing with," he said. "Consequently, ththe highest rates of back pain and back surgery in the world."
According to Carey, 80 percent of people have back pain. That is pain that is so severe that a person is unable to do usual activities for at least one day. About 3 percent or 1/3 of the people that have a bout of back pain sees a doctor. Only 39 percent back pain sufferers in NC seek a chiropractor first and 1/5 see back pain specialists such as orthopedic surgeons. Very few people see a physical therapist first largely because of costs. Most insurance companies in North Carolina require a referral from an MD prior to seeking care from a physical therapist. In otherthat's not the case.
Carey said this is a huge issue for society since medical costs for back pain is over $25 billion. One insurance company reported to Carey that their back pain inflation rate is 8 percent per year.
Although 8 percent of the population gets acute low back pain, only 4 out of 10 people get care. "Costs in North Carolina for acute and chronic back pain care are responsible for a $65 tax on every adult in the state," Carey said. "So we're all paying for everyone else's back pain."
Exercise and education are interventions that work, according to Carey. On the other hand, he said spinal fusion and epidural steroids are interventions that do not work. The worse thing to do during an episode of back pain is to go to bed. As soon as possible, he suggests getting back to usual daily activities especially walking.
Carey said physicians should look for the following "red flag" symptoms during an initial evaluation for back pain:
- weight loss
- history of non-skin malignancy
- chronic steroid use, osteoporosis
- significant trauma
According to Carey, back pain sufferers should see a physician when the following symptoms are present:
- unrelenting severe pain for more than 2 weeks
- leg weakness
- a "red flag" underlying condition
- significant trauma
- symptoms don't improve after 2 weeks
- unable to work for more than 5 days