Erin, a 28-year-old graduate student, lives with chronic upper back problems. The pain is brutal sometimes, and her back locks up for no reason. she tried many different remedies and found that chiropractic care and acupuncture both work well. after a session of either, she feels immediate relief. still, she must have regular treatment or her back will seize up again. Erin, who asked that her last name not be used, is far from alone — chronic back pain is one of the most common maladies affecting Americans. according to the American Academy of Family Physicians, nine of 10 people experience back pain during their lifetimes.

What Causes Back Pain?

Some sore backs result from a car accident or trying to pick up something heavy. most common, however, is back pain arising from “the cumulative microtrauma through years of living,” in the words of Appleton, Wis., chiropractor Matthew Lederer.

Other experts echo those thoughts.

“In our culture, long hours in a car and seated at a desk are a recipe for eventual back problems,” said David Saum, an acupuncturist with Southview Acupuncture Clinic in South St. Paul, Minn. “The most common causes of back pain are overwork and trauma — sometimes the first leads to the second.”

According to an overview of back pain from the National Institute of Health, the back is uniquely complicated. It is made up of dozens of bones, muscles and nerves, all of which must be in harmony. a slight strain in one muscle or a slight misalignment between two bones can constrict a nerve, causing back pain.

Chiropractors such as Lederer take X-rays to ensure that patients’ spines are in need of realignment.

“What I see most often in the X-rays I take are spinal degeneration, osteoarthritis, degenerative disc disease or other conditions,” he said.

Treating The Pain

Surgery may be necessary for more serious cases of back pain, but Lederer emphasized that it is only an option after more conservative options have been exhausted. He cited a recent article in the Journal of the American Medical Association that showed back surgery and certain exercise programs yield about the same results.

Manipulation from a chiropractor is a much less drastic method for helping resolve the imbalance that causes the pain. Chiropractors go through years of training to learn how to adjust joints enough to restore a normal range of motion.

Spinal manipulation — often accompanied by the “pop” of air being moved from a joint — is not a full solution by itself. according to Lederer, “chiropractic care now and exercise later” is the best approach. He gives patients exercises to perform that will strengthen back muscles, and he also emphasizes the need for periodic adjustments.

Long-Term Solutions

Of course, if your job is contributing to your back problems, it may be necessary to change the conditions in which you work.

“Most commonly, people do not realize the ergonomic measures they should be taking,” said Lederer. “People often wait until a problem emerges rather than doing preventative care.”

Your employer may offer an ergonomic assessment that can rearrange your workspace and put your back in a better position. Ergonomics experts can teach you how to work in a way that does not strain your back.

They can also give you equipment that lessens the strain on your body such as ergonomic mouse pads and keyboards. good back health involves more than just sitting straight — hand strain can contribute to back pain, and vice versa.

Does Poking Work?

In the U.S., more and more people are finding traditional Chinese medicine to be a helpful remedy. In his work in alternative medicine, Saum takes a broad, holistic approach to patient care.

“Our training tells us to look for supporting factors or constitutional weaknesses that can be treated as well,” said Saum. “This leads to a better, more effective treatment.”The treatments vary according to the types of pain and the predilections of the patient. We treat the symptoms and the cause, or ‘root and branch.’”

Perhaps the most prevalent treatment in Chinese medicine is acupuncture. Acupuncture involves piercing the skin with very small needles. The needles themselves are so thin that they seldom cause a “stinging” sensation, but they are noticeable.

“Each patient has to be treated individually according to their constitution,” he said.

Mainstream medical opinion is generally favorable of acupuncture, provided it is done by a trained expert. According to WebMD, many rigorous studies, including several by the National Institutes of Health, have concluded that acupuncture is effective in lessening pain.

However, the medical community has few accepted explanations for why it works.

BACKGROUND: A study was undertaken to identify the diagnostic approaches that primary care physicians and gynecologists undertake in women with symptoms associated with ovarian cancer.

METHODS: A vignette-based survey was mailed to 3200 primary care physicians from the American Medical Association Physician Masterfile. the vignette described a 55-year-old woman with symptoms associated with ovarian cancer, although ovarian cancer was never mentioned. the authors evaluated patient, physician, and practice characteristics associated with a workup that could detect ovarian cancer.

RESULTS: the survey response rate was 61.7%. after exclusions, 1532 physicians were included. Overall, 89.5% of physicians reported that they would recommend testing that can detect ovarian cancer (71.2% ultrasound; 25.4% pelvic computed tomography; 26.5% CA125). in adjusted analysis, the only patient factor associated with ovarian cancer testing was symptom type, genitourinary versus gastrointestinal (risk ratio, 1.07; 95% confidence interval, 1.03-1.11). Physician and practice characteristics associated with recommending of ovarian cancer testing included specialty (gynecologists > family physicians and internists); type of practice (group > solo); clinical teaching (yes > no); and within Census division, location of practice, with all Central (East, West, North, and South) and Atlantic (Middle and South) areas having a lower likelihood than New England.

CONCLUSIONS: On the basis of a vignette in which a woman reported symptoms associated with ovarian cancer, the majority of primary care physicians and gynecologists would not recommend CA125, but would recommend imaging of the pelvis. Gynecologists, physicians involved with clinical teaching, and those in group practices were significantly more likely to recommend testing that could lead to an ovarian cancer diagnosis.

See the full abstract here

CME Information

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CREDITS Physicians: 0.25 AMA PRA Category 1 Credit(s)™ AccreditationThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Pennsylvania School of Medicine and MedPage Today. The University of Pennsylvania School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Family Physicians: 0.25 Elective credits Release Date: Mar. 21, 2011 Expiration Date: Mar. 21, 2012 Estimated time for completion: 15 minutes There is no fee for this activity. To Receive CME/CE CreditIn order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. you may then follow the directions to print your certificate of participation.

Program Overview Among the many issues clinicians face today, staying current with advances in medicine is becoming a major challenge. Teaching Brief® articles will allow clinicians to stay up-to-date and assimilate new information into their daily practice. The content of these Teaching brief articles has been validated through an independent expert peer review process.

Learning Objectives upon successful completion of this educational program, the reader should be able to: 1. Discuss the results of this study2. Review the relevance and significance of the study in the broader context of clinical care

Disclosures Dori F. Zaleznik, MD, and Ed Susman, and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

The staff of The University of Pennsylvania School of Medicine Office of CME and the staff of MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.