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On The Cover/Top Stories
Back Break New treatments offer hope to those with bad backs, but picking one can be just as painful as the aches that ail you.Todd Douglas fought searing back pain for more than a decade. The 32-year-old computer technician consulted 13 doctors, took ten different painkillers and endured four agonizing spinal injections of cortisone. "I was taking a handful of pills a day just to exist," he says. Last year his doctor, James Rathmell at the nearby University of Vermont Medical School in Burlington, pinpointed the problem: a cracking disc between two of his vertebrae. Douglas had three options: Continue to manage the pain with medication, have open-back surgery to fuse the vertebrae, or undergo an experimental, less-invasive treatment that shrinks the damaged disc by sticking a hot wire into it. Douglas decided on the hot wire last October, with the university picking up the $10,000 tab as part of a clinical trial of the new procedure. He has been pain free ever since. His treatment, called intradiscal electrothermal therapy, or IDET, is the latest in a wave of new remedies for back pain, an ailment that continues to torment the masses. A cure has eluded researchers, despite years of intensive study. Four of five adults have periodic back pain, and it is one of the leading causes of missed workdays in the U.S., costing insurers and employers $45 billion in 1999. A bad back pushed baseball iron man Cal Ripken into early retirement and forced President Kennedy into a rocking chair during staff meetings. The spine's downfall stems from its beautiful complexity: 33 vertebrae separated by jelly-doughnut-like discs, all wrapped in twisting muscle and ligaments. A $100-billion-a-year industry has risen from correcting the failures in and shocks to that structure. Some new treatments are legitimate and noteworthy. Many more are unproven or just plain kooky. New surgical hardware from companies such as Medtronic (nyse: MDT - news - people ) and Endius makes spinal surgery far less invasive and risky. Painkillers and muscle relaxants such as Merck's (nyse: MRK - news - people ) Vioxx and Wyeth's (nyse: WYE - news - people ) Robaxin improve on medications like Motrin and Aleve. On closer inspection a lot of hyped remedies and preventatives fail. The back belts worn by employees at your local Home Depot failed to prevent injury according to a 1997 federal study. "Memory foam" beds are a fad, as is the Blue Stuff, a cream whose main ingredient is emu oil. Sufferers swear by the Stuff on its Web site, but the fine print says it is not a cure-all for anything. Cutting-edge solutions have hit snags before. A 20/20 exposé of surgical screws in 1993 prompted a rash of lawsuits claiming the screws broke or doctors failed to disclose their lack of FDA approval. (Screws won approval in 1998.) One screwmaker, Acromed, now part of Johnson & Johnson (nyse: JNJ - news - people ), paid $100 million to settle thousands of suits in 1996. "Hopefully, the vast majority [of doctors] subjugate profit motive to an altruistic motive," says Dr. Paul Rubery, director of the Strong Health Spine Center at the University of Rochester in upstate New York. Nine out of ten sufferers will get better in six to eight weeks by exercising and taking an occasional pain pill. For those who need surgery, the current gold standards are operations called discectomy (removal of part of the disc) and spinal fusion combined with discography, in which a surgeon watches on screen as he pricks each disc to pinpoint the source of pain. Once the culprit is found a small section of the back is cut open and part or all of the damaged disc is removed and the surrounding vertebrae are fused with screws, rods or cages. Almost 200,000 people a year undergo fusions and 80% get better. Yet surgery can often trigger a placebo effect, or its reverse. In a 2000 Stanford University study of 50 discectomy patients, 40% of patients said the surgery cured them, but they felt pain during a postoperation discography. Another 40% said the surgery failed, but they felt no pain during subsequent discography. "Some people have a tendency to feel pain even when they don't have pain," says the study's co-author, Eugene Carragee. Two prominent back specialists who know back-pain controversy well are the Saal brothers, Jeffrey Saal and Joel Saal, the creators of IDET. Now professors at Stanford, they trained as physiatrists--specialists in physical rehabilitation. The Saals drew criticism in 1989 by championing exercise over immobility to treat bad backs. Now physical therapy is standard treatment. Chart Diagram -
Divorce And Dollars - 9/27/02 8:00:00 AM ET From the most expensive to the bitterest--our look at how the very rich break up. Hires And Fires: Sept. 23 - 27, 2002 - 9/28/02 12:00:00 PM ET Pressler leaves Disney to head Gap; Vivendi shakes up board; Deloitte & Touche's Copeland to step down. The Week Ahead: Oct. 30 - Nov. 4, 2002 - 9/28/02 12:00:00 PM ET Fastow indictment seen; Lucent's Russo may resort to reverse split; Eisner faces more shareholder ire. Lord of the Skies - 10/14/02 12:00:00 AM ET JetBlue has the best profit margins of any airline. Is it the next Southwest--or another People Express? The First Rich List - 9/27/02 12:00:00 PM ET Forbes compiled its first ranking of America's richest way back in 1918.  |
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