Back-pain sufferers cost US more than $100 billion annually

Back-pain sufferers in America cost this country more than $100 billion annually in medical bills, disability and lost productivity at work. And 80 percent of Americans will battle back pain at some point in their lives, making it the number two reason for doctor visits, after coughs and other respiratory infections, Newsweek reports.

To relieve the pain, Americans wanted a quick fix and thus, between 1996 and 2001, there was a 77 percent increase in spinal-fusion surgery, the most costly (about $34,000 a pop) and invasive form of therapy. But, as General Editor Claudia Kalb reports in the April 26 cover story, "Treating Back Pain," (on newsstands Monday, April 19), many of these procedures simply don't work and doctors are now looking for simpler, more effective ways to treat one of the most vexing problems in medicine. "We've come to the point where we have to think out of the box," says Harvard researcher Dr. David Eisenberg, who is studying nonsurgical alternatives like massage and acupuncture. "The time is now." Kalb examines the controversy around spinal fusion and alternatives to treating pain.

Chiropractic treatment, the most popular nonsurgical back therapy, is booming, with 60,000 chiropractors practicing today, a 50 percent increase since 1990. While experts generally agree that the treatment, which involves spinal manipulation and stretching, is safe for the lower back, there's not a lot of data on how effective it is in the long term. Dr. Dan Cherkin, of the Center for Health Studies in Seattle, is now conducting the first large trial of the practice.

Massage has seen an increasing number of addicted patients, too, and research shows it does help knead out persistent pain; one study even found that patients took fewer medications during treatment, Kalb reports. Acupuncture is also popular, though there's a dearth of evidence about its effectiveness.

But even conventional doctors say if it makes you feel better, go for it. Dr. Jeffrey Ngeow, an anethesiologist by training, pushes the tiny needles into patients at New York's Integrative Care Center. He says acupuncture, which seems to stimulate the release of feel-good endorphins, won't provide instant relief, but it will have a cumulative effect. And then there's back pain's relationship to stress. Dr. John Sarno, of NYU Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost all back pain is rooted in bottled-up emotions. He says patients need to recognize the connection between mind and body before they'll feel better. In addition, there is currently an NIH-funded pilot program at Harvard where a diverse group of 25 specialists -- surgeons as well as complementary medicine experts -- are educating one another on how they diagnose and treat back pain. The goal: to see if there is a more efficient, multidisciplinary way to attack the problem -- and to make it cost-effective, too.