HEALTH MATTERS: Your health questions answered

Q. I’ve been having low back pain. Do I need an X-ray of my spine?

A. Low back pain is quite common and can be debilitating. Most cases are not caused by a serious underlying condition such as cancer or an infection and tend to get better within a few weeks to a month.

Treatment includes medication for pain and inflammation, heating pad and exercise; prolonged bed rest is no longer prescribed as a routine measure. Imaging of the spine with X-rays, computed tomography or magnetic resonance imaging usually is indicated when there is a suspicion of a serious underlying medical condition or if there is pressure on the nerve from a herniated disc. Otherwise, imaging studies are not ordinarily needed, or helpful.

I have some personal experience with this topic as I suffered a herniated lumbar disc in late November of last year. It turns out that I needed an MRI, because my pain was so severe that I was hospitalized twice for pain control. The MRI showed I had severe nerve root compression by the herniated disc.

After three weeks of conservative therapy, I wasn’t getting better, so I underwent surgery for partial disc removal. That was two months ago, and I’m pleased to say that I’m back to work, although I’m not sure that I’ll ever get back to jogging. The bottom line is that my story is unusual—the majority of people with low back pain get better on their own, and most do not need any imaging study. Good luck with your back pain; I hope that you feel better soon.

Q. I have no known heart or vascular disease. Should I take aspirin to prevent a heart attack or stroke?

A. The use of aspirin in this setting is a two-edged sword, as aspirin does have some modest ability to prevent cardiovascular events in asymptomatic people, but it does so with a concomitant increase in the risk of bleeding.

Routine aspirin use in people without known heart or vascular disease (so-called primary prevention) does not appear to reduce the overall risk of death, but the risk of heart attack in men aged 45 to 79 and the risk of stroke in women aged 55 to 79 appears to be reduced. However, this benefit is marred by an increased risk of bleeding, often internal, in both men and women.

I recommend aspirin only in people at higher risk for heart or vascular disease — such as those with high cholesterol, diabetes, high blood pressure, cigarette smoking or a family history of heart disease at a young age — who are not predisposed to bleeding. To try to limit the risk of bleeding, I generally recommend a small dose of aspirin, such as a single baby aspirin per day or every other day. I always discuss the potential benefits and risks with the patient, so the patient is involved in the decision.

Remember, though, that these comments apply only to people without known heart or vascular disease — almost all patients with overt heart and vascular disease require lifelong aspirin therapy as prescribed by their health care providers. The best advice that I can give you is to discuss the options with your health care provider before you start taking any medication — especially aspirin.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 N. Columbia Rd, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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