Treatment for Pain in the Back: A Retrospective

Early Back Pain Treatments

Back pain has been an enduring, unwanted feature of human existence. The first evidence of treatments for back pain appeared more than 7000 years before the Common Era (BCE). In the Stone Age, holes were drilled in the person’s head to let out evil spirits and demons that were causing the pain. The Chinese were treating pain in the back as early as four thousand years BCE. The first written record of this approach dates to 2500 years BCE.

By the second millennium BCE civilizations such as the Egyptians, Sumerians and Assyrians considered back pain to be untreatable. As such, no attempt appears to have been made to surgically treat the condition. In some instances, however, non-invasive treatments such as massage and poultices made from various plants and herbs were used.

Greek and Roman Back Pain Treatments

The rise of the Greek civilization (2900-1150 BCE) renewed various attempts to use surgery to correct back problems. From ancient writings it is known that heat, stretching and other forms of spinal manipulation were also used as an alternative to surgery.

Regarded as the “Father of Medicine,” Hippocrates (approx. 460-379 BCE), was renowned for performing surgery on the brain. There is some question as to whether, or how often, he performed surgery on the back to relieve pain. However, he did describe the use of herbs, joint manipulation and traction as treatment for pain in the back.

Approximately 100 years BCE, the famous Roman physician Claudius Galen used surgery, massage, exercise and diet to treat back pain. He was noted for his attempts to develop treatments to restore the balance of the four bodily humors (blood, yellow bile, black bile and phlegm) and to understand the construction and function of the human body. He is considered second only to Hippocrates in terms of early contributions to the field of medicine.

Although back pain treatment continued in the East, there are few written records of back pain treatment during the dark and Middle ages in the West. With the beginning of the Renaissance, interest in medicine and how the human body functioned was renewed. Perhaps the most famous contributor to the understanding of the human body during this period was Leonardo da Vinci (1452-1519). As a result of the knowledge gained from his secret dissections and depictions of the human body he is known as the Father of Anatomic Art. In addition, massage therapy for the treatment of pain became popular in the West during this period.

Development of Surgical Procedures for Back Pain

By the 17th century therapeutic rest became a popular form of treatment for back pain. Some physicians during this period experimented with open surgical approaches on the back and spine to achieve pain resolution. But because there was no understanding of the role of germs or bacteria, there was no concern for the need for a sterile operating environment or for personal hygiene, and open surgery was a highly dangerous undertaking. This was the age when barbers and butchers performed medical procedures.

In the 18th century manipulation and electrostatic devices were used for spine-related pain treatment. Venesection (phlebotomy or bleeding), or opening of the veins, applying leeches, and cupping continued to be employed as pain management alternatives. Open surgery continued to be limited due to the absence of effective anesthetics and understanding of the human anatomy.

The 19th century saw hydrotherapy and magnet therapy added to the physician’s pain management armamentarium. Marijuana was thought to be a safe and effective treatment for back pain. At the beginning of the century ether was discovered to be an effective anesthetic, thereby allowing less painful surgeries to be undertaken. By the middle of the century antiseptic surgery was introduced. Heroin joined morphine as acceptable non-invasive pain management alternatives. Toward the end of the century the invention of the x-ray jump-started rapid advancements in medical science.

20th Century Back Pain Treatments

The 20th century was a period of remarkable advances in the art and science of medicine. Although it may be politically incorrect to say, the two world wars and other military conflicts enabled physicians to make incredible leaps forward in surgical medicine and pain treatment that in all likelihood would not have been possible otherwise. To list all of the advances that occurred during 20th century far exceeds the scope of this article. However some of the major discoveries deserve mention: blood typing, antibiotics, vaccines for poliomyelitis and measles, drug therapy for the treatment of acute and chronic pain, pacemakers, immunosuppressive drugs for vital organ transplants, lasers and fiber optics for endoscopic, minimally invasive surgery, microsurgical techniques, computerized imaging technologies (CAT and MRI), and specialized instrumentation for back surgery and brain surgery including computer guided navigation.