More than 50 million Americans suffer from chronic pain much of it untreated. But when pain sufferers do get medical care, they often receive overtreatment. Why is that? Insurance companies and Medicare reimburse doctors for surgery and other invasive procedures so that’s what doctors are likely to provide.
Insurance doesn’t pay doctors to counsel patients about low-tech remedies, such as exercise and stress relief even though these sometimes are the best ways to deal with persistent pain.
Here’s how pain problems are frequently misdiagnosed and mistreated and what you can do to get effective, commonsense pain relief…
Back pain
Up to 80% of Americans suffer from low back pain at some point in their lives. Medical treatment for this chronic problem is based on the assumption that anatomical problems, such as herniated discs, cause the pain. A standard treatment is to operate, sometimes by surgically fusing the vertebrae (bones of the spine).
In reality, bones and discs usually don’t cause low back pain. Sprained or strained muscles, ligaments and tendons soft tissue made vulnerable to injury by overexertion and lack of exercise underlie most cases.
Scientific evidence: In a study published in Spine, orthopedic surgeons treated 64 patients, ages 25 to 60, who had low back pain that had lasted one year or longer. X-rays showed degenerated discs. Half the group received surgery (fusion of the lumbar vertebrae). Half got nonsurgical treatments, including counseling and exercise.
A year after treatment, researchers evaluated both groups for pain, use of pain medication and other factors indicating treatment success or failure. The non-surgery group had a higher success rate 76% compared with 70% of the surgery group (a clinically significant difference). And the non-surgery group hadn’t been subjected to the pain, risk and inconvenience of surgery.
Neck pain
In patients over age 40 who suffer from neck pain, a magnetic resonance imaging (MRI) scan or X-ray usually reveals degenerative changes in the vertebrae of the neck. Surgery may be recommended, but these changes are not the cause of most cases of neck pain.
A classic cause of neck (and shoulder) pain is working at a computer where the keyboard is too high or the chair too low forcing the forearms into a position that creates a less than 90- degree angle in the elbow. This raises shoulder muscles, causing tension and pain in the neck and shoulders. Other common causes of neck pain are reading or watching television in bed and cradling the telephone on your shoulder.
Shoulder pain
Shoulder pain and stiffness frequently are diagnosed as a rotator cuff tear, adhesive capsulitis (frozen shoulder) or “impingement syndrome” (a narrowed space between two rotator cuff muscles).
Your doctor may recommend surgery, followed by painful rehabilitation that may last as long as five months. Pain is generally relieved, but in some cases, patients never regain full function. Nonsurgical treatment to restore strength and flexibility to shoulder muscles can work as well as surgery and there’s no harm in trying it first.
Scientific evidence: Six months after “conservative” treatment for shoulder pain shoulder exercises, physical therapy, ultrasound and pain-relieving steroid injections 64 out of 82 patients had significant pain relief and increased function, according to a study published in Archives of Physical Medicine and Rehabilitation.
Headache
People with chronic migraine or tension headaches or both (mixed headache syndrome) usually are prescribed pain medications which are costly and can damage the stomach, liver and/or kidneys with long-term use. But chronically tense mid back, neck and shoulder muscles are a common cause of headache and muscle tension can be treated without drugs.
Scientific evidence: A study published in Cochrane Database of Systematic Reviews analyzed 22 other scientific studies on headache treatments, with a total of 2,628 participants. Nondrug therapies, such as spinal manipulation, were as effective as medications or even more so for reducing the incidence of migraine or chronic tension headaches.
Better ways to reduce pain
• Find a pain specialist
Your first stop should be your primary care physician, who can refer you to a pain specialist. He/she can perform a physical examination that evaluates muscles surrounding the painful joint for strength and flexibility as well as for spasm and trigger points (a tender muscle that refers pain to another part of the body) an assessment that will show if muscles are causing the pain.
• Exercise
Inactivity is the number-one cause of pain. Perform aerobic exercise daily.
Example: Brisk walking fast enough to break a sweat two to three miles a day. Most people who also perform the following exercises daily will notice improvement in the first three weeks, with additional results in six months.
Best exercises for low back pain
Perform four repetitions of each of the following basic lower-body exercises daily…
1. Diaphragmatic breathing
Lie on your back, arms at your sides and knees bent. Slowly inhale through your nose, rounding out your belly. Then exhale through your mouth.
2. Shoulder shrug
Pull your shoulders up toward your ears as you inhale through your nose. Then exhale through your mouth as you let your shoulders fall back down.
3. Leg slide
Lie on your back, arms at your sides and knees bent. Slide your right leg down until it is flat on the h floor. Relax the right leg for three seconds. Slide your right leg back to bent position. Repeat with your left leg.
4. Head rotation
Lie on your back, arms at your sides and knees bent. Drop your head to the left side. Return your head to center. Then drop your head to the right side.
5. Single knee to chest
Lie on your back, arms at your sides and knees bent. Bring your left knee to your chest as far as you comfortably can. Return your left leg to bent-knee position, and then let it slide down until it is flat on the floor. Relax the left leg for three seconds, and then slide it back to the bent-knee position. Repeat with your right leg.
6. Side-lying knee to chest
Lie on your left side, knees bent, and head resting on your elbow. Bring your right leg toward your chest, letting the knee drop toward the floor. Then slide your right leg back, extending the knee until your leg is straight. Bring your leg back to the starting position. Roll onto your opposite side and repeat.
7. Buttocks squeeze
Lie on your stomach and place a pillow under your belly. Tighten your buttocks muscles and hold for two seconds. Relax the muscles.
Best exercises for neck pain, shoulder pain and headache
Perform four repetitions of each of the following basic upper-body exercises daily. Begin with lower-body exercises 1, 2 and 4 (under “Best Exercises for Low Back Pain”).
1. Elbow bend
Lie on your back, arms at your sides and legs extended. As you slowly inhale through your nose, close your fists and bend your elbows. Bring both arms toward your head. As you slowly exhale through your mouth, relax your arms and hands and let your arms drop back to your sides.
2. Chicken wings
Lie on your back, arms at your sides and legs extended. Rest your hands on your chest, elbows at your sides. Keeping your elbows down as much as possible, move them so they are pointing behind you. Return to the starting position.
3. Horizontal abduction adduction
Lie on your back, hands at your sides and legs extended. Extend your right arm out – to the side. Bring your right arm across your chest. Then return it to the extended position. Repeat with your left arm.
4. Shoulder rotation
Lie on your back, arms at your sides and legs extended. Extend your right arm out to the side. Bend your elbow and point your fingers behind you, getting your arm as flat on the floor as possible. Keeping your elbow on the floor, raise your arm 90 degrees so that your fingers are pointing toward the ceiling. Repeat. Then move your arm toward the floor, palm down, placing your arm as flat on the floor as possible. Raise your arm 90 degrees, fingers pointing toward the ceiling. Repeat. Perform the entire sequence with your left arm.
5. Shoulder bend
Lie on your back, arms at your sides and legs extended. As you slowly inhale through your nose, extend your arms behind your head, arms as flat on the floor as possible. As you slowly exhale through your mouth, return your arms to the starting position.
