After the common cold, back pain is the most frequent ailment of Americans seeking medical advice. It has been conservatively estimated that 10 to 30 percent of the U.S. population suffers from back pain at any given moment. That would be about 30 million people at a minimum. Several thousand of them are experiencing it for the first time.
What is done about it? Too often surgery, contends Paul Altrocchi, MD, MPH, in an eye-opening , well-argued book, Stop Harmful Surgery: Back Pain, a New Approach at Last, published by Xlibris Corporation.
A graduate of Harvard Medical School and the Neurological Institute, Dr. Altrocchi became an Assistant Professor of Neurology at Stanford Medical School. He writes, "I began to realize that my back pain patients did not improve following recommendations and actually would have been better off had they never seen me." He asked his colleagues for approval to stop consulting on lumbar back pain until he had figured out why his analysis and management of the ailment was not more effective.
After quite some time, he concluded that it was not his analysis, but the "M.D. model" for treating back pain that was flawed. That model was based on the widespread belief among physicians that back pain resulted primarily from diseases such as disc deterioration and osteoarthritic degeneration of the spine, things best treated by surgery.
After seeing a number of patients who had gone through multiple surgical procedures without any improvement in their condition, he concluded that most back pain was not caused by diseases that required surgery, but by "mechanical" dysfunctions. If he was right, how best to analyze and treat these dysfunctions?
He found the answer at Michigan State University's College of Osteopathic Medicine. There, he says, "an assemblage of open-minded, remarkably gifted clinicians had put together a different medical model [based] on an intricate knowledge of anatomy and physiology [function], including every bone, muscle, tendon, figment, joint and nerve in the human body."
He learned this new model carefully and concluded, "The mystifying world of low back pain was no longer mystifying." Looking back over his experiences, he found that many back pain problems involved people who did much lifting in their activities. He cites the case of a lumber millworker; also a housewife, who twisted to lift a vacuum cleaner from a closet and immediately experienced sharp back pain.
Dr. Altrocchi gives us several fascinating -- and heart-wrenching -- case histories, along with discussion of studies and research into back pain. The book has useful charts and photos to explain the workings of the spine, and even several cartoons about back pain. He also includes a history of "manual medicine."
Though there are not yet many MDs who have adopted the new "model" for analyzing and treating back pain, there are others. As he notes, neurological surgeons are trained to do -- surgery. Nevertheless, some of them are coming around to the view that surgery should be the last resort, with other mitigations coming ahead of it.
Dr. Altrocchi is frank about his goal in writing the book and sharing his experience: "… to persuade back pain patients everywhere that the caregiver they should seek first seek when back pain occurs is a practitioner of manual medicine." By that he means, "the best chiropractor in the community, or a physical therapist trained in osteopathic techniques, or, if one is available, a doctor of osteopathy specializing in manual medicine or an M.D. familiar with the osteopathic model for lumbar back pain.
I chose a chiropractor. After three months, I said "goodbye" to back pain.
Mr. Hannaford had chronic back pain from a horseback riding accident. He writes from California.
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