had battled lower back pain for three months with hot showers,
analgesic heat rubs and heating pads, it finally happened.
Chris Roth awoke one morning barely able to move.
a huge problem for Roth. As owner of Steel City Ballroom in a
Pittsburgh suburb, he teaches the trademark hip-shaking and
body-twisting steps of ballroom dancing. "I canceled my
lessons," said Roth, 44. "Iíd had back pain but
not like that. This was the most extreme pain. Thatís when I
couldnít push through it."
for Roth, Anthony Delitto was a student. The chairman of the
University of Pittsburgh department of physical therapy in the
School of Health and Rehabilitation Sciences offered to help.
office, Delitto analyzed Rothís posture and how he walked to
figure out the potential source of his pain. Then he had him
lie down on his back and cross his legs in a figure-four
position. Then he pounced on him and rocked him back and forth
a few times. They heard a pop. The pain vanished. The hip was
realigned. Back to the ballroom.
efforts to continue dancing throughout the pain actually
represents a new approach to treating lower back pain. Donít
shut down. Remain active. Push through the pain so it doesnít
that concept, Patient-Centered Outcomes Research Institute has
awarded the University of Pittsburgh $14 million over five
years to lead a national trial to test whether a more
aggressive European treatment can better prevent acute lower
back pain from becoming a chronic condition in which the level
of pain magnifies and is more difficult and expensive to
in the trial include Intermountain Healthcare in Salt Lake
City, Johns Hopkins Hospital and Health System in Baltimore,
the Boston Medical Center and the Medical University of South
will lead the trial to test the European treatment against
"usual care" in which the doctor decides on
patients are more inclined to worry that when their back hurts
they are further harming it, causing them to become
inactive," he said. "That can seriously impede
recovery and cause further damage, leading to chronic back
back pain, especially with no signs of a fracture or muscle
damage, makes it imperative that the person stay active, in
shape and on the job. "Chronic lower back pain is clearly
something we would like to avoid," Delitto said.
lower back pain can stab like a knife when a person picks up a
dropped pencil or lifts a child. Or it could be the swing of a
golf club or a slip on the ice.
it occurs, acute lower back pain can flash periodically
throughout the day and continue for weeks, months and even
longer. If it extends beyond six months, the pain could become
chronic. About 10 percent of those experiencing lower back
pain end up with a chronic condition.
annual health care cost of lower back pain in the United
States is $86 billion, a Journal of the American Medical
Association study reports, making it one of the costliest
conditions in American medicine.
Patient-Centered Outcomes Research Institute is a nonprofit,
nongovernmental organization created through the Affordable
Care Act of 2010. Its mandate is to improve health care by
helping patients, caregivers, clinicians, employers, insurers
and policy makers make more informed health decisions. It
funds projects that compare the costs and effectiveness of
context, the Pittburgh-based trial will compare the
"usual care" approach against the European strategy,
which involves a primary care physician and a physical
therapist. Cognitive behavior therapy can help the patient put
back pain in perspective and persuade the patient to continue
doing everyday activities.
"Target," the project will recruit 60 primary care
clinics affiliated with the five medical centers including
University of Pittsburgh Medical Center. Each randomly will be
assigned to follow one of the two protocols.
said the trial will include 2,640 patients with acute lower
back pain experienced less than half the time and for less
than six months. Researchers will evaluate them based on their
response to pain and their predisposition to avoiding pain out
of fear of further injury. The team also will document the
number of X-rays, surgeries and other related medical
procedures each patient has experienced.
Health Organization report on lower back pain says risk
factors include "occupational posture, depressive moods,
obesity, body height and age," while noting that its
causes and onsets "remain obscure and diagnosis difficult
pain is not a disease but a constellation of symptoms. In most
cases, the origins remain unknown," the report says.
good for the heart is good for the back. You have to be active
and engaging in life. Walking and exercise are important to
health," Delitto said. "We think we can improve
outcomes in patients, so there is less a tendency of chronic
lower back pain."
Carey, director of the Cecil G. Sheps Center for Health
Services Research at University of North Carolina Chapel Hill,
has conducted several back pain studies over the past 25
years. He said heís familiar with the Pittsburgh project.
back pain is tremendously disabling, with high costs in terms
of medical expenses and time off work, as well as the burden
of chronic pain and reduced function by patients," he