I've been searching the web looking for some help for my back pain. I know from an MRI that I have a herniated disc at L4,5. What I can't find is -- what's the best treatment for this problem? Everywhere I look it's a different suggestion from bed rest to acupuncture to surgery. Is there any consensus?

You have just discovered the dilemma patients and doctors face every day. Evidence-based medicine requires that treatment applied must be proven effective -- otherwise what's the point of spending time and money on something that doesn't work?

But study after study either shows the treatment didn't make any difference or one study says 'Yes' it helped and another says 'No' it didn't.

Recently a group of researchers did us all a favor. They carefully reviewed the results of traditional, alternative, and surgical treatment for lumbar disc herniations. What they found mirrors your own discovery. Here are a few highlights:

  • Bed rest may help but two days isn't better than seven days.
  • Physical therapy is a reliable way to treat back pain from a herniated disc but it's not clear if one type of exercise works better than another.
  • Acupuncture, massage, and manipulation don't help in the acute phase (first six weeks).
  • A corset or lumbar support doesn't seem to make any difference.
  • Seventy percent of the people get better in the first two to four weeks, so immediate surgery isn't advised unless there are serious neurologic problems.
  • Surgery helps some people but we still don't know how to predict who will be helped and who won't; some people are worse after surgery.
  • Younger patients (less than 40 years old) seem to do better than older adults.
  • Steroid injections help half the time when used before trying surgery.

    Without a clear "best" treatment, this group of researchers suggests taking it one step at a time. Wait and see if your body heals on its own. If it doesn't, then try physical therapy. If that doesn't help, consider steroid injections and/or surgery.

    Very long-term studies show that the final result (10 years later) seems to be about the same for all patients regardless of the treatment. Some say if this is so, then find the path that works best for you based on symptom control.

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