Diagnosing Back Pain Is Difficult

Emily Browning, left, and Kit Harington star in "Pompeii." (Caitlin Cronenberg/TriStar Pictures/MCT)

Emily Browning, left, and Kit Harington star in "Pompeii." (Caitlin Cronenberg/TriStar Pictures/MCT)

Dear Dr. Roach: I have had lower-back problems almost all my life. Many doctors and therapists have examined it, with almost no success. Recently my attacks have been fewer and milder, even if the bed is not quite right. I can live with it, but a new wrinkle has emerged: If I don’t get out of bed as soon as the alarm sounds, I’ll have back pain and little mobility all day and partial incapacity. I am 74 years old, 6 feet, 4 inches tall and weigh 230 pounds. Do you have any idea what causes this, and if there is any cure? — J.S.B.

Answer: There are dozens of causes of back pain, and it can be impossible, even with the most advanced diagnostic tests, to make a precise diagnosis of the underlying cause.

In your case, it sounds like you have had one problem for a long time and now something is causing a different kind of back problem. Back pain that gets worse with bed rest and better with exercise is not likely to be a herniated disc or spinal stenosis —two serious causes of back pain. I am guessing that there is a component of osteoarthritis in your back now, which would be quite common in a 74-year-old man. Osteoarthritis does tend to get worse with rest and better with exercise. I am impressed by how acutely it gets worse, and it’s entirely possible that there may be some muscular spasm associated with your back pain.

Even though you are quite tall, 230 pounds is a lot for your spine to support. You have a BMI of 28, which is in the “overweight” range. Losing even five or 10 pounds may help relieve pain on your back. And certainly listen to your body, and get up and be active. Stretching, including yoga and tai chi, can be a very effective treatment.

Dear Dr. Roach: I need some medications, like Dulcolax and Miralax, for some tests. The generics are so much cheaper. Is there much difference, compared with the expensive brand? —J.M.

Answer: In my experience, there is almost no difference between the brand name and the generic for prescription and most over-the-counter medicines. The quantity and quality of the active ingredient is regulated. The inactive ingredients occasionally may cause a reaction in a sensitive person.

Most physicians, including myself, use generic brands for themselves and their families. I certainly have had patients who insist on the brand name, but most of the time it is a waste of money.

Dr. Roach Writes: In early January, I wrote about progressive supranuclear palsy. I wrote about the need for evaluation of swallowing, since this is a prevalent problem not only in this illness, but in many neurologic conditions. I did not mention the invaluable assistance of the speech and language pathologist. An experienced neurologist uses the speech and language pathologist to evaluate the swallowing problems as well as to provide guidance on safe eating and drinking.

One woman wrote in to tell me of the difficult decision she had to make about whether to place a feeding tube in her husband when his illness became severe. It’s very important that all of us, no matter our age, have designated a health-care proxy, a person to help make decisions when we are unable to do so, but it’s equally important to discuss with that person ahead of time what our wishes would be under certain circumstances. Most hospitals have proxy forms available. A lawyer also may be helpful but is not necessary.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.