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DEAR DR. ROACH: I feel the need to comment on your recent column on chiropractic therapy for back pain. Having 27 years of back pain, I want to give S.B. some additional thoughts. Seventeen years ago, before my neurosurgeon implanted a titanium device in my lower spine, he asked about other corrective efforts that I’d made before deciding on surgery. I mentioned to him the years of chiropractic therapy I’d tried.

His reaction was swift. He said that if my pain had been due to nerve encroaching on bone or nerve on muscle tissue, chiropractic manipulation would have been helpful; he then explained that I had neither of those. He felt, in my case, that chiropractic treatment was severely wrong. The wearing away of my disc would be worsened by the constant grinding movements of the manipulation procedure; this just promotes further deterioration!

I’d like to tell S.B. one more thing about living with back pain: Neither chiropractic, nor surgery, nor painkillers have given me a pain-free life. The most helpful coping skills have come from physical and occupational therapies, which have promoted the skills and understanding of how to live with my degenerative condition.

Unfortunately, as with many ailments, there is no “one size fits all” approach to back pain. I know this only because I’ve tried every single one of them. I hope S.B. will not lose hope, but will gain confidence and understanding that help support his travel along a path I know all too well. — S.S.

ANSWER: Thank you for your thoughtful letter. Back pain is a symptom coming from a wide spectrum of diseases, and the therapies we have are appropriate only for some types. However, most young people with no identifiable structural cause for their pain will do well with several types of therapies, including medication, physical therapy or manipulation. If people aren’t getting better with a therapy, it’s time to re-evaluate the whole situation, consider imaging studies to find out what is wrong and, in a very few cases, consider surgery.

DEAR DR. ROACH: I had pneumonia at the end of 2016, and in a follow-up with my primary-care doctor, he said I had some crackling in the right lower lobe of my lung. I had a chest X-ray in April, and nothing abnormal was found. I just had my six-month checkup, and the crackles are still there. Should he have ordered another chest X-ray? Do I need to be concerned that he’s overlooking something? I am 69 years old and quit smoking 1985. — J.S.

ANSWER: “Crackles” is a technical term for a lung sound that is heard with the stethoscope. It can represent fluid in the lungs, partial collapse of the lung, infection or one of a few other causes. Sometimes, after a bout of pneumonia, there could be some scarring, which might explain the crackles.

However, in any person with a history of smoking, the risk for both infection and tumor is much higher than in the general population. The risk of lung cancer starts going down after you quit, but it never goes down all the way to that of a person who never smoked; although, it gets close after 15 years or so.

Pneumonia can be caused by obstruction from a small lung tumor, one that might not show up on a chest X-ray. So if the abnormality on your exam persists, I think a follow-up chest X-ray or even a CT scan would be prudent. This is my opinion: There’s no absolute right answer here, but I would sleep better at night with more reassurance.

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 request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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