Bad-back Attack If It's Cramping Your Style,you Don't Have To Take It Lying Down Aging Baby Boomers Turn To New Strategies In The War Against Pain

October 21, 1990|By A.M. CHAPLIN

In last Sunday's Sun Magazine, an article about back pai failed to make clear that osteopaths receive the same training as medical doctors as well as training in osteopathy and that their title is doctor of osteopathy. They may prescribe drugs and do surgery in addition to performing the corrective manipulations of the musculoskeletal system that osteopathy emphasizes.

The Sun regrets the error.

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The way Joanna Watson sees it, she brought it on herself.

She was working on her house one weekend, scraping and painting and doing all those things people do to keep their houses looking the way they want them to look. And yes, her back was hurting, but what's a little back pain?

FOR THE RECORD - CORRECTION

So Ms. Watson took aspirin and kept on scraping. And then, when the pain began to get worse as the weekend progressed, she started working even harder because she knew, deep down in that dark corner of the mind where people keep the thoughts they don't want to pay attention to, that if she kept this up she wouldn't be able to work on her house at all.

Which is exactly what happened.

So then came the visits to the doctors -- three of them. They agreed on nothing, except that she didn't need surgery. After them came the physical therapist who was lousy, and then the physical therapist who was great, and in between the acupuncturist and the massage therapist and even the car dealer when it became necessary to trade in the almost-paid-up standard-shift car that had become too painful to drive.

Six months after that weekend, Ms. Watson has improved considerably under the care of the second physical therapist, but she is still unable to work more than half-time at her job as a caseworker in the office of U.S. Sen. Paul S. Sarbanes. She wonders if the experience has changed her personality, and then she tells you it has.

She has learned -- only because she's had to, she says -- to respect her back, not to abuse it just because she can get away with it. And she's learned some other, less tangible thing, having to do with acceptance, and facing-up, and the uncomfortable knowledge of limits and mortality.

"I'm used to going 90 miles an hour 20 hours a day, and now I can't move," Ms. Watson says. "It makes you very introspective." She adds, rather sadly, "It's like growing up, you know."

JOANNA WATSON'S STORY has all the elements of the classic back-pain epic: the pain and the fury, the frustrating search for answers, the false gurus and the true ones -- even the final breakthrough to transcendence and the wish to send everybody you know to your physical therapist.

It's not a rare epic -- millions of Americans suffer from episodes of back pain each year, putting it second only to the cold and flu as a cause for missing work. Most of it isn't "serious" -- that is, it's not likely to need surgery and it will probably go away by itself in a few days or a few weeks. Still, it's hell when you have it, and a lot of people have it.

Some estimates put the proportion of workers who have suffered back pain at some point in their careers at 85 percent, and others say the percentage is increasing as American life becomes ever more sedentary.

Certainly it seems likely that the number of back patients will continue to grow as more and more of that bulge in the population known as the baby boom enters the prime back-pain years of middle age. These boomers, like Ms. Watson, who is 46, will face an expanding maze of diagnostic and treatment options -- a maze that reflects the confusion about the best way to treat most back pain.

For the fact is that, despite the omnipresence of aching backs, not a whole lot is known about how to fix them. We can replace the hips, the lungs, the kidneys and even the heart -- but is anybody out there talking about replacing the spine?

THERE WAS A TIME, though, when it did seem as though the medical profession had the answers to back pain. That was in the heyday of back surgery, which started in the late '60s and extended into the mid-'80s, according to Mehrdad "Mike" Massumi, head of physical medicine and rehabilitation at Greater Baltimore Medical Center. In those years surgical procedures on the back changed the thinking about back pain. "Live with it" became passe; the new concept was "cure." If you want a military analogy, think surgical strike: Get in there quickly, clean it up, and look, Ma! All better!

Many people were helped by this approach -- but many were not, and quite a few, in fact, ended up worse than before. Studies began to appear that showed untreated patients doing as well as those who'd had surgery, and recent estimates of the proportion of surgical failures run as high as 40 percent.

So if you want to talk breakthrough in the treatment of back pain, suggests neurosurgeon Edward Tarlov, co-author of "Back Attack," don't talk about flashy new surgical procedures. Instead look at what Dr. Tarlov considers the real breakthrough: a better understanding on the part of conscientious physicians as to who needs surgery and who doesn't.

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