No one-size-fits-all therapy for back problems
Question: I feel the need to comment on your recent column on chiropractic therapy for back pain. Having 27 years of back pain, I want to give
S.B. some additional thoughts. Seventeen years ago, before my neurosurgeon implanted a titanium device in my lower spine, he asked about other corrective efffffffffffforts that I’d made before deciding on surgery. I mentioned to him the years of chiropractic therapy I’d tried.
He said that if my pain had been due to nerve encroaching on bone or nerve on muscle tissue, chiropractic manipulation would have been helpful; he then explained that I had neither of those. He felt, in my case, that chiropractic treatment was severely wrong. The wearing away of my disc would be worsened by the constant grinding movements of the manipulation procedure; this just promotes further deterioration!
I’d like to tell S.B. one more thing about living with back pain: Neither chiropractic, nor surgery, nor painkillers have given me a pain-free life. The most helpful coping skills have come from physical and occupational therapies.
Unfortunately, as with many ailments, there is no “one size fifits all” approach to back pain. I know this only because I’ve tried every single one of them. I hope S.B. will not lose hope. — S.S.
Answer: Back pain is a symptom coming from a wide spectrum of diseases, and the therapies we have are appropriate only for some types. However, most young people with no identififiable structural cause for their pain will do well with several types of therapies, including medication, physical therapy or manipulation. If people aren’t getting better with a therapy, it’s time to re-evaluate the whole situation, consider imaging studies to fifind out what is wrong and, in a very few cases, consider surgery.
Q: I had pneumonia at the end of 2016, and in a followup with my primary-care doctor, he said I had some crackling in the right lower lobe of my lung. I had a chest X-ray in April, and nothing abnormal was found. I just had my six-month checkup, and the crackles are still there. Should he have ordered another chest X-ray? I am 69 years old and quit smoking 1985. — J.S.
A: “Crackles” is a technical term for a lung sound that is heard with the stethoscope. It can represent flfluid in the lungs, partial collapse of the lung, infection or one of a few other causes.
However, in any person with a history of smoking, the risk for both infection and tumor is much higher than in the general population.
Pneumonia can be caused by obstruction from a small lung tumor, one that might not show up on a chest X-ray. So if the abnormality on your exam persists, I think a follow-up chest X-ray or even a CT scan would be prudent.