Back pain - Macro impact and prevention

Investment Analysis Clubs Macro Economic Trends and Risks
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Back pain is the #1 cause of disability in the U.S. In 2019, 39% of adults had back pain. Adults aged 65 and over, women, non-Hispanic white adults, and those with income below 100% of the federal poverty level (FPL) were most likely to experience back pain.

In 2020, low back pain (LBP) affected 619 million people globally and it is estimated that the number of cases will increase to 843 million cases by 2050, driven largely by population expansion and ageing. LBP is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.

Back pain has a Macroeconomic impact because it can prevent people from working and may qualify a patient for SSDI. Itā€™s a costly problem even though itā€™s not potentially fatal like heart disease, cancer or diabetes.

Only 10% of non-surgical treatments for back problems kill pain, says review

Only six out of 56 treatments analysed yielded ā€˜smallā€™ relief according to most comprehensive worldwide study, with some even increasing pain
by Denis Campbell

Tue 18 Mar 2025 Denis Campbell, The Guardian, Tue 18 Mar 2025

Most treatments for back pain do not work and even the few that do bring little relief, a global review of the evidence on one of the worldā€™s commonest health problems has found.

Six in 10 adults in the UK live with lower back pain at some point. Symptoms can include excruciating pain, restricted movement, inability to work and reluctance to mix socially. Some people feel better within weeks but others can find their life dominated by chronic pain for years.

The wide range of treatment available includes painkillers, acupuncture, stretching, massage, anti-inflammatory drugs, laser and light therapy, and manipulation of the spine.

However, the bad news for the many who endure back pain is that only 10% of these non-surgical treatments usually deployed actually have any effect ā€“ and the rest provide little or no benefitā€¦

The one treatment that does help those with acute low-back pain is non-steroidal anti-inflammatory drugs (NSAIDs), they found. In addition, five treatments also bring some relief for chronic low-back pain: exercise, spinal manipulative therapy, taping, antidepressants and what are known as transient receptor potential vanilloid 1 (TPRV1) drugsā€¦

Exercise has been shown to be the most helpful treatment for back pain. ā€¦ [end quote]

Note the difference between acute back pain (where you pull out your back suddenly) and chronic (which lasts a long time).

The real solution for back pain is prevention.

Lift safely.

Stretch and strengthen your back muscles as well as your abdominal core. Stretch daily because muscles need constant attention.

Maintain a normal weight. Wear orthotics in your shoes if your feet or ankles are uneven since that can stress your back.

Wendy

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Romanian deadlifts, light weight.

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Dr. Haas in Palo Alto, who was Joe Montanaā€™s doctor, relieved my incapacitating back pain instantly with an epidural injection. Is that considered surgical or non-surgical treatment?

Before the procedure Dr. Haas had me authorize a procedure that could kill me. I pondered the CYA document for some time before signing.

It worked like magic! After that I was enrolled in physical therapy to strengthen my back.

The Captain

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If it was just a steroid injection then no, itā€™s not surgery. Though lumbar epidural steroid injection is not life threatening unless you have diabetes or very high blood pressure; so maybe it was a different treatement.

If that plus physical therapy relieved the pain long term then you are lucky. For a lot of people steroid injection only works temporarily as it does not remove the cause of the inflammation, just symptoms.

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ā€œRomanian deadlifts, light weight.ā€

squats, without weight as strength is built, are a great exercise. Only need to go as low as thighs parallel to floor.
I use a kettlebell to make it harder.
Pullups are also really good, as the hang portion of the pullup really stretches out the upper body, and the up portion of the pullup works core and all of the upper body.

Main thing is do something, or lose the ability to move.
Walking/hiking is as easy as it gets, but itā€™s 100% weight bearing, and it is something the vast majority of people can do.

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My doctor had a much better idea, SEX! Good exercise! Strong motivation.

The Captain

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I like your Doctor !

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Naw, only my wrist gets stronger. . .

Holy grail is planks.

And quit sitting in crappy chairs. They taught good posture in school. Think about it next time you sit down in front of the TV. . .

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Pfftā€¦who needs a doctor to provide the motivation. If looking good nekkid doesnā€™t work as a motivator all by itself, I wouldnā€™t give much for the chances of anything a doctor has to say on the topic.

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My back pain journey.
I have had minor back pain since age 50.
That pain has progressively gotten worse since until I decided to do something about it in 2024 [age 73].
I had gotten a CT scan in 2020 for something else but the radiologist mentioned degenerative changes to the spine.

The doctor requested a MRI of the spine.
It mentioned disc height loss in L1,2,3,4,&5.
At l3-L4 joint severe spinal canal narrowing with moderate righted neural foraminal narrowing [in other words the nerves at that location were being pinched].
A steroid dexamethasone was injected. For 12 days I was 18 again with zero pain. But the pain returned rapidly. It is my understanding that in some patients the steroid can work for months.
Radio frequency ablation was performed at the site. A 10-20 minute procedure with minimal pain.
I have a ~75% pain reduction that has lasted 6 months so far. I check back with the doctor in another 6 months or if the pain increases significantly. The procedure can be done repeatedly I suppose.
I have a daily routine of walking 1.5 to 2 miles plus physical therapy exercises for the lower back and some light weights & inclined push ups & tricep dips for strength training.

Radio frequency ablation involves burning the offending nerve with an electrode.

It is my understanding that this procedure can be done on the neck, knee & hip in addition to the lower back.

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As someone who has some experience with this. It isnā€™t really the exercise that helps but rather strengthening the back, shoulders and neck muscles. Age is fighting against you so you have to (somewhat) gently increase your exercises and get stronger.
As you do this youā€™ll probably get some tightness which can be relieved via NSAIDs and/or a chiropractor.

Mike

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Totally. In the morning I make coffee with my moka pot. It takes about 4 minutes. While I am waiting, I do 3 sets of 30 goblet squats, I do them fast but with light weight. If I donā€™t do anything else that day at least I have the squats.

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Father time catches up with most seniors.

Think you donā€™t have to worry about back problems as you get older? Unfortunately, science says otherwise.

Results from a 2018 study published in The Spine Journal found that spinal degeneration is both prevalent and fairly progressive among older adults. In fact, CT scans of the spine taken 6 years apart among over 1,200 cohort members of the Framingham study found that upwards of one-third of adults between the ages of 40 and 59 have moderate to severe degenerative disc disease. Over 50 percent also have moderate to severe spinal osteoarthritis.
40 to 59. Thatā€™s not even old.

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I have had OA (inherited) since birth. Diagnosed at 8. No treatment (1950s-60s). No real problems until 2016. I had regular X-rays due to hip replacement (2004). For those 12 yrs, no significant spread of OA. That all changed in 2016. Walking through the bedroom, back went PAIN !! and it almost knocked me down. Made it to the bed, and satā€“a lot. Eventually pain went away. Went to see orthopedic surgeon who did several surgeries on meā€“including my hip replacement. Suddenly, the OA was generally widespread throughout my bodyā€“including my back. This is a very large independent practice, with hundreds of doctors over 20-40+ large facilities. The one I go to has its own MRI and a third floor with multiple operating rooms (only for outpatient). They are about two blocks from a major hospital. The building, etc is all owned and operated by the business. So when I went to see them about my back, I was talking to multiple doctors, not just one, about what had happened. When I described what had happened, they all said ā€œyeah, that is pretty standard for OAā€. The treatment you received is called a rhizotomy. I had all the lumbar (L1-L5, plus one above and below) nerves burned out 3-4 years ago. So far, nothing has grown back. But I still have significant back pain and can not stand upright for more than two minutes or soā€“else it starts to hurt and I need to sit down and wait for the pain to go away.

A rhizotomy is a surgical procedure that involves cutting or destroying specific nerve fibers (roots) in the spinal cord. This procedure is typically used to treat chronic pain or spasticity (muscle stiffness). There are a LOT of nerves in the back, and there is no way to get them all with rhizotomy. The doctors tried a number of times (5+ times) and no further improvement. Medicare paid for it because they only pay for results. No successful results = test is experimental. Try again elsewhere in the back. Took four treatments (over 12-18 months) to get both sides of the lumbar spine area (total of seven nerves on each side) burned out. They will not do more than 4-5 at a time (donā€™t ask why). After the fifth or sixth failed treatment in a row, I finally gave up trying because they were running out of reasonable choices after more than 1-2 yrs.

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Science is falsifiable.

To say that a certain hypothesis is falsifiable is to say that there is possible evidence that would not count as consistent with the hypothesis.

According to Popper, evidence cannot establish a scientific hypothesis, it can only ā€œfalsifyā€ it. A scientific hypothesis is therefore a falsifiable conjecture.

In other words, Science is not Religion, itā€™s a tool to increase human understanding.

The Captain

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Maybe we should go back to walking on all fours?

I am one of the many with back issues. Iā€™ve had 3 surgeries, two in the neck for spinal spondylosis, and one lower back for spinal stenosis. Prior to each I was so incapacitated I could barely get across the house even with a walker. Afterwards I can now walk freely, although I use the electric carts in the supermarket because of the distance involved going up and down every aisle.

Recovery from the neck surgeries was several weeks, from the lower back spinal fusion more like six months, and that was the worst, BY FAR.

I understand why people got addicted to oxy and other things, when you have the pain it is relentless and affects every single thing you do. And the oxy makes it go away. I had it for a short while after the lower back surgery, but theyā€™re a lot more careful with it now.

An Aleve gives me a couple hours relief, rarely but occasionally two (not recommended except under a doctorā€™s supervision) and Iā€™m pretty normal. But itā€™s definitely a huge change in lifestyle once it starts.

Oh, and Iā€™ve lost an inch-and-a-half in height, so thereā€™s some serious disc compression going on all over, I guess. Shouldā€™a spent more time on all fours.

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After reading jerryab2 & Goofhoofy sagas; I feel purty lucky. I am still capable of walking a mile or two daily.

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@jerryab2 @Goofyhoofy please accept my sympathy for your suffering.

When I showed my GP a video of me doing a handstand for my 70th birthday her reaction was, ā€œI wish that some of my patients had your joints.ā€

Thatā€™s the problem with orthopedic issues (such as my younger sisterā€™s severe scoliosis and osteoporosis). They are terribly painful even though they arenā€™t fatal. We joke sometimes that I specialize in fatal diseases that (so far) have been curable by surgery (splenectomy, hysterectomy, bilateral mastectomy, open-heart surgery to replace a stenotic aortic valve and aortic aneurysm) whereas she is perfectly healthy except her skeleton is falling apart.

Wendy

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About two decades ago, I worked with a guy who had major back issues. He also lost about an inch and a half of height (from 6ā€™ 1" to just under 6ā€™ as I recall) over the years of back problems. Finally he had enough and travelled to Germany for a week to have a surgery (insertion of a prosthetic vertebra) that wasnā€™t approved [yet] in the USA. He showed us (weā€™re all engineers, so it is of interest to us) a video (not a real live video, but a representation of it) of the surgery and it was really cool. The first cool thing is that they enter through the FRONT of the body, not the back. Thatā€™s because it is too dangerous to enter through the back where the spinal cord and other nerves are located. So they open a small slit by the navel, then they literally push the inner organs aside, and insert a long tool. The tool is stainless steel and had multiple concentric pieces for various tasks, and a camera and cutter/drill/vacuum at the end. And of course, the prosthetic vertebra is connected at the end as well. They slowly cut out the bad vertebra and vacuum out the debris, then they rough up the upper and lower parts, and then they insert the prosthetic vertebra. It is spring loaded (enters completely closed) and using the innermost part of the concentric tools, it is slowly screwed open with the spring pushing the upper part up and the lower part down. Apparently each part has special rough edges with some sort of material bonded to the metal that will ā€œknitā€ into the material above and below similarly to the way a prosthetic hip knits. Once the part is properly inserted, they twist the inner part a little more until it completely detaches from the prosthetic part. And then they remove the tool, allow the organs to move back into place, and close up the entry at the navel (maybe special glue nowadays). I wish I could find that video again to post it here (Iā€™ve searched and found all sorts of videos about this, but not the one I recall from all those year ago).

That is just the surgical part. Then, the afternoon of the surgery, they had him go into their pool and swim a bit. Then a checkup and I think some imaging to check if all is in order. And each day for the next 6 days, morning, afternoon, and evening, he went into the pool to swim a bit, more each time. On the morning of the 8th day, they discharged him and he went to the airport and came home. Two or three days later he was back at work. He said he had minimal pain even just one week after the surgery. And ā€¦ he got almost his entire height back almost immediately. I canā€™t tell the difference between 5ā€™ 11 1/2" and 6ā€™ 1", but he measured and sure enough it was correct.

The whole thing, including the one week stay at the facility (kind of a hospital plus hotel combined) cost about $40,000 which he paid for out of his own pocket. Later, he submitted claims to the health insurance company, and after some arguing over 6+ months, they reimbursed him for nearly 3/4 of the total bill. He figures it saved them at least $100k for the surgeries that he would have had to do in the US had he not taken a chance on this new (at the time) technique in Germany.

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Basically, the metal pieces on each end have a lot of small holes (through the metal, not just into it) which the bone of the upper and lower vertebrae can grow into and thus form a solid bone anchor at each end.

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