Backache

Backache

Both my wife and I share a propensity for back problems. Peggy is a good example of how back problems often run in families. She and her two sisters (like their late mother) all have a peculiar kink in the same area of their backs that causes them grief, especially following extended kitchen work at sink height.

As for me, Scrooge that I am, I blame my most serious back problem on Christmas. It was December 23, 1991, when Peggy and I went to a nearby Christmas tree farm to select a living tree. Wanting to replant the tree, I dug a big ball of earth with it and managed to heave it into the wheelbarrow the owner had lent me. I successfully wheeled that 100-pound load 100 yards up the hill to my station wagon, but when I attempted to lift it from the wheelbarrow to the wagon's trunk, something snapped.

Agony ensued. It grew worse as we drove home. Santa's back was ruined. I could not lie, sit or stand comfortably. I slept terribly, sideways on a couch with three pillows under my left side. The only help we could find the
following day, Christmas Eve, was a chiropractor. He took a $95 x-ray, declined to do major manipulations and said that I should see an orthopedist.

A week later, the orthopedist said I should consult a neurosurgeon. Not surprisingly, he said I needed surgery. He insisted this was my only option, given my x-rays. So ultimately (two months later), I had surgery followed by physical therapy. I also used healing herbs and had acupuncture treatments. I think the alternative treatments gave me more relief than the physicians.

Backaches Abound

It seems that everywhere I look, people have back problems. That's not surprising, because aching backs are one of America's most prevalent health problems. Estimates vary, but the experts generally agree that somewhere between two and five million Americans suffer serious back pain each year.

At some point in life, about four out of five Americans experience back pain severe enough to require medical intervention--anything from taking aspirin to major surgery. And at any given moment, something like one-quarter of the country is dealing with previous back trouble by taking medication, doing exercises or making other lifestyle adjustments to convalesce and keep from reinjuring their backs.

Bad backs also cost the country a fortune--$16 billion a year in medical treatment and $80 billion in lost wages and productivity.

Be Wary of Surgery

Doctors used to treat back pain with rest, long-term medication and surgery. Now they will generally recommend short-term medication, exercise and, increasingly, chiropractic, yoga or some other formerly scorned alternative therapy.

I'm glad surgery has fallen out of favor. My own back surgery was useless. I did not seek a second opinion, even though friends advised me to. Why? Because I'm a lazy cheapskate who goes with the flow of an HMO, and I wanted so desperately to put my back pain behind me.

I'll go to my grave not knowing whether the surgery did me any good. I have since learned that cervical fusion--the operation I endured--is another of those overperformed operations. I found out that bad x-rays don't always mean bad backs and that good x-rays don't always mean good backs. I learned that 80 percent of people in the kind of distress I had recover in four months without surgery.

But unrelenting pain makes people desperate. We Americans undergo a lot less back surgery than we used to, but there are still about 20 times more back operations per capita in the United States than in Canada and Europe. So here's my advice: If a doctor says you need back surgery, get several other opinions before going under the knife. I should have, but now that's water over the dam.

In the meantime, what can you do about the pain? Immediately after a back injury or a flare-up of back pain, doctors recommend pain-relieving and anti-inflammatory medications such as aspirin and other nonsteroidal anti-inflammatory drugs. For really bad pain, stronger medications might be necessary, including codeine or other narcotics. If you're in serious pain, I'd suggest taking whatever the doctor orders. Recently, physicians are more inclined to give slow-release morphine, which actually comes from an herbal source--the opium poppy.

Green Pharmacy for Backache

For lesser pain or lingering pain, there are a number of herbal alternatives that can prove helpful.

Red pepper (Capsicum, various species). Red pepper contains a marvelous pain-relieving chemical--capsaicin--that is so potent that a tiny amount provides the active ingredient in some powerful pharmaceutical topical analgesics. One product, Zostrix, contains only 0.025 percent capsaicin.

At this point, I don't know (or care) whether red pepper's effectiveness is due to capsaicin's ability to interfere with pain perception, to its ability to trigger release of the body's own pain-relieving endorphins, to its salicylates, or to all three. All I know is that it works.

You can buy a commercial cream containing capsaicin and use that. Outside the United States, however, people simply use red pepper. You can, too, at considerable savings. A hot pepper costs a few cents, while capsaicin drugs cost a few dollars.

You can mash a red pepper and rub it directly on the painful area. You can also take any white skin cream that you have on hand--cold cream will do--and mix in enough red pepper to turn it pink.

Whether you use a cream or a hot pepper, be sure to wash your hands thoroughly afterward: You don't want to get it in your eyes. Also, since some people are quite sensitive to this compound, you should test it on a small area of skin to make sure that it's okay for you to use before using it on a larger area. If it seems to irritate your skin, discontinue use.

Willow (Salix, various species) and other forms of natural aspirin. I have no problem with taking aspirin, since it was originally derived from an herbal source. It originally came from compounds known as salicylates that occur naturally in willow bark, meadowsweet and wintergreen. Any of these herbs can be made into pain-relieving teas.

Many salicylate-rich plants also contain methyl-salicylate, an aspirin-like compound with a particularly pleasing smell. One is wintergreen. Another is birch bark, once used by American Indians to make a tea that they drank or applied externally to treat lower back pain. On occasion I have made such teas by throwing roughly a handful of birch bark or wintergreen into a cup or two of boiling water and letting it steep for about ten minutes. (Remember, though, that if you're allergic to aspirin, you probably shouldn't use aspirin-like herbs, either.)

Oil of wintergreen, which is high in methyl-salicylate, also serves as a good pain reliever for external use. It may be applied during massage. (Please make sure you keep oil of wintergreen out of children's reach. It has a tempting aroma, but ingesting even a little can prove fatal.)

White Willow The salicin in willow is "herbal aspirin" and has been used to relieve pain since 500 b.c.

Peppermint (Mentha piperita) and other mints. You will find the compounds menthol and camphor in many over-the-counter backache medications. They are chemicals that can help ease the muscle tightness that contributes to many bad backs. Menthol is a natural constituent of plants in the mint family, particularly peppermint and spearmint, although the aromatic oils of all the other mints contain it as well. Camphor occurs in spike lavender, hyssop and coriander.

Assorted essential oils. Treatment with essential oils can often help relieve the painful muscle spasms that contribute to back pain. Several of these--sage, rosemary, thyme, horsebalm and mountain dittany--are rich in thymol and carvacrol, compounds that help muscles relax.

To use any of these oils, add a few drops to a couple of tablespoons of any vegetable oil and massage the oil mixture directly into the affected area. You might also add a few drops of the oil to a hot bath and soak for a while, inhaling the steamy vapors. (Remember, though, never to ingest an essential oil, as small quantities of some oils, on the order of a single teaspoon, can be fatal.)

Other compounds with potent muscle-relaxing action that can relieve back spasms are borneol and bornyl-acetate. Plants rich in these chemicals include cardamom, sage and rosemary. My database tells me that borneol is an effective antispasmodic compound at a very dilute concentration, making it even more potent than menthol, camphor, thymol and carvacrol.

There are also a few other oils that you should know about. Aromatherapists often suggest using the oils of birch, lavender, black pepper, clary, ginger and marjoram to alleviate backache. I would not hesitate to use any of these, as all have a folkloric history for relieving cramps or backaches, and all contain pain-relieving and muscle-relaxing compounds.

Why use the plant oil if you can obtain chemically isolated menthol or some other muscle-relaxing chemical? Because, in my opinion, the whole aromatic herb oil is likely to work better. These oils evolved to protect the plants from pests and other environmental stresses. The fact that aromatic herb oils evolved into a chemically complex mixture suggests that all the chemicals in them work together.