You have a back ache. Like millions of others in your situation, you open your browser and search for "back pain." The various health sites in the search results instruct you to apply ice, to apply heat, to rest it, and not to rest it.
They advise you that the pain should go away on its own within 72 hours, while simultaneously informing you that your achy back could be a symptom of a serious, even life-threatening illness, so you should make an appointment to see your doctor right away.
In other words, your guess is as good as theirs.
According to a 2013 Pew Research Center report (PDF), 35 percent of US adults have searched the Web for information about a specific medical condition they believe they or someone else may have. Of the 72 percent of Internet users who report having looked for medical information online in the previous year, more than three out of four began their search at Google, Bing, Yahoo, or another search engine, according to the survey. Thirteen percent of respondents started their search on a specialty health-information site such as WebMD.
When I searched "back pain" on about a dozen popular health-information sites, the recommended treatments for a mild or moderate back ache often contradicted each other. For example, the Treatment & Care page of WebMD's Back Pain Health Center states that "No specific back exercises were found that improved pain or increased functional ability in people with acute back pain."
Go to Wikipedia's back-pain page and you find this statement: "Exercises can be an effective approach to reducing pain, but should be done under supervision of a licensed health professional." (Granted, the entry later points out that exercise may not be as effective for reducing acute back pain as resuming regular activities as quickly as possible.)
Speaking of Wikipedia, consumers aren't the only ones turning to the user-written encyclopedia for treatment advice. The Atlantic's Julie Beck reports on a survey by the IMS Institute for Healthcare Informatics that found 50 percent physicians search for health information on Wikipedia. That makes Wikipedia the most popular source for medical information by patients and doctors alike.
Many big-name health sites seem to emphasize professional treatment alternatives over self help. For instance, WebMD's back-treatment page describes about a dozen surgical and nonsurgical procedures before providing, near the very bottom, a link to an explanation of various home treatments.
Similarly, the Mayo Clinic site lists dozens of potential causes of back pain, including polio, thoracic and abdominal aortic aneurysms, osteoporosis, and eyestrain. The site's "When to see a doctor" page helps you determine whether your condition is serious, but it doesn't offer any treatment advice beyond recommending over-the-counter pain medicine and the application of heat or cold.
I understand wanting to err on the side of caution. In this vein, as it were, most of the health-info sites begin by helping you determine whether you have an emergency on your hands, and if so, to call for help immediately (more on identifying medical emergencies below).
Tapping the crowd for healthcare tips
A new site called CureCrowd attempts to aggregate the collected wisdom of its visitors to offer ratings of the effectiveness of various medical-treatment alternatives. Enter your malady or a type of treatment in the search box on the site's home page, and then select one of the entries that appears. If there is no entry for your illness or treatment, you can add it to the site.
The various treatments for the selected malady are graphed with an effectiveness rating of 0 (no improvement or worse) to 4 (cured). The screen at the top of this post shows the initial treatments listed for back pain. To rate a treatment yourself, you have to register with the site by providing an email address and password. You can also use your Facebook ID to sign in.
The nonprescription back-pain treatment rated highest by the CureCrowd crowd is yoga, followed by inversion therapy and massage. However, no more than a few dozen users have rated any single treatment, so the sample may be too low to be statistically significant. Not being a statistician, I'll take the CureCrowd survey results at face value.
CureCrowd invites visitors to complete their own survey of their experiences with various medical treatments. The site was founded by doctors but makes no recommendations of its own. Instead, the service's "medical team" reviews all user treatment suggestions before adding them to its database, according to CureCrowd's About page.
Gauging the trustworthiness of health-info sites
Online health-information services are not subject to the restrictions of the US Health Insurance Portability and Accountability Act (HIPAA) and other privacy regulations with which healthcare providers must comply. Nor is there a way to determine whether the information the sites provide is accurate and up to date.
The US Department of Health and Human Services' National Institute on Aging provides guidelines for assessing the trustworthiness of online health information. Among the suggestions are to look for the site's sponsor and a way to contact the sponsor. Articles should be attributed to a specific author whose qualifications are listed, and all the site's content should be reviewed by an editorial board or other advisory body.
Last but definitely not least, beware of unrealistic claims of miraculous cures, and be cautious about any offers that require a payment. Always look for corroboration of claims from other sources, and be sure to check with your doctor or other health professional before starting or discontinuing any treatment.
Another resource for evaluating online health information is MedlinePlus, which is operated by the US National Library of Medicine and the National Institutes of Health. The site links to dozens of legitimate public and private sources for health information and journal articles.
The NIH also sponsors the National Human Genome Research Institute, which has created a resource for assessing the reliability of online health information. The page explains how to review scientific and medical literature, and how to judge the quality of educational materials relating to genetic conditions.
One of the resources the NHGRI links to is Trust It or Trash It? The site is designed to help consumers "think critically about the quality of health information" regardless of the information's source. The three options on the home page are "Who said it?", "When did they say it?", and "How do they know?"
The US Federal Trade Commission offers a guide to reliable medical information geared specifically to seniors. Among the organizations the site links to are HealthFinder.gov, the Centers for Disease Control and Prevention, and Womenshealth.gov.
The claims of alternative-medicine purveyors can be particularly difficult to vet. The National Institutes of Health's National Center for Complementary and Alternative medicine provides guidelines and resources for evaluating nontraditional health treatments. As with any treatment suggested online, the agency recommends that you check with your health care provider before trying it.
Help for your aching back
After visiting more than a dozen online resources for back-pain sufferers, the one I found most effective is from InsiderMedicine, not only because it combines video and text explanations of the causes and treatments of back pain, but also because it starts by helping you determine whether your pain is an indication of a medical emergency.
In the video, Alan Platt, a physician's assistant and instructor at the Emory School of Medicine, describes the symptoms that might indicate the need to seek immediate medical help, such as severe pain radiating from your stomach to your back, or loss of bladder control.
Another helpful resource in determining whether your back pain requires the attention of a medical professional is Handout on Health: Back Pain from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The handout recommends that you call your doctor if the pain is due to a recent fall or is accompanied by fever or numbness/weakness in your legs.
Healthline's SymptomChecker lists 29 possible causes for lower-back pain. The conditions are listed in order from most common to least common, and while the entries are often technical, they include information on when to seek medical attention and recommended at-home treatments.
Medicine.net offers a slideshow that explains the symptoms, causes, and treatments for lower-back pain. The site also features an interactive symptom checker "powered by WebMD" that starts by asking your gender and age, and then has you select a body part and symptom to see a list of possible conditions.