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This is MORNING EDITION, from NPR News. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

In our personal health report, we continue our series on back pain. Today, chronic back pain, and we begin with NPR's Patricia Neighmond, who examines medications and other alternatives.

PATRICIA NEIGHMOND reporting:

Scott Fishman runs the pain management program at the University of California- Davis. By the time patients get to him, their back pain is so severe it radiates down the leg and limits their activities. Many can barely walk. They can't shop for groceries, go to family outings, exercise, or even work. Dr. Fishman.

Dr. SCOTT FISHMAN (Pain Management Program, University of California-Davis): When we get stopped in our tracks from the pain that we have, then we start to get deconditioned, both physically and emotionally, and it becomes a vicious cycle and a downward spiral.

NEIGHMOND: Years ago, doctors recommended patients go to bed and stay there in order to heal. No more, says Fishman. In fact, not moving could be the worst thing you could do.

Dr. FISHMAN: You've probably heard that, after a surgery, the sooner we get someone up and moving, the sooner they resolve and are able to get home and are discharged from the hospital. Same with back pain--these joints, for them to clear out toxins and to feed themselves and to regenerate, need movement to move fluids in and out of them.

NEIGHMOND: The first step toward making movement tolerable, says Fishman, is over-the-counter medications like aspirin or ibuprofen that work by diluting the power of the nerve pathways to the brain. For most patients, after a couple days of medication and movement, the pain goes away. But for some, it lingers, and that's where medication problems can begin.

Dr. FISHMAN: Most people have a view that these drugs, since they're over-the- counter, are nontoxic, that they don't have any side effects. And in fact, that's not the case. These drugs come with a whole host of side effects, particularly if taken in greater than the recommended doses, or taken for long periods of time.

NEIGHMOND: For example, aspirin and ibuprofen can cause stomach ulcers, increased bleeding, and even damage kidneys. Tylenol can adversely affect the liver. For some patients, morphine-like prescription drugs may be an option. Vicodin, Percocet, and Oxycontin are the Gold Standard of pain relief, says Fishman, because they're so potent and effective. But for those who don't like the idea of being on medication every day, there are alternatives.

Dr. HERBERT BENSON (Professor, Mind Body Medical Institute, Harvard University): Now, if you would sit up, please. Close your eyes and relax all of your muscles, starting with your feet, your calves, your thighs.

NEIGHMOND: At the Mind/Body Medical Institute outside of Boston, Harvard Professor Herbert Benson helps patients harness their body's innate capacity to heal itself. This patient focuses on her breath, and silently repeats a special word, a meditative state, says Benson, that can eliminate the effects of stress.

Dr. BENSON: Stress does not cause pain, but it can make it worse. And the anti- stress approach of the relaxation response can change the brain's perceptions of what it's experiencing, and help erase the memory of pain which is often leading to the pain's long-term duration.

NEIGHMOND: Often, the pain is still there, says Benson, but the relaxation response helps patients live with it, and return to normal activities. For some patients, he says, the pain disappears completely.

Patricia Neighmond, NPR News.

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