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Back Pain

Current Treatments For Back Pain

Last updated on:
20/03/2012

Contributing Author: Guy Slowik FRCS

Nearly nine out of ten people with back pain will recover without treatment within the first month. Treatment depends on the condition that is causing the pain. Some of the conventional treatments that have long been used to treat back pain - including traction, corsets, and electrical stimulation - are now accepted to be generally unhelpful for many sufferers, though some do obtain benefit.

Nonsurgical treatments for back pain include:

Heat And Cold

When a back injury occurs, the use of heat or cold applied to the back may be helpful.

  • Use cold within the first 48 hours after the back symptoms start. Apply a cold pack (or a bag of ice) to the painful area for five to ten minutes at a time. This can control excessive inflammation and provide pain relief.
  • Use heat if symptoms last longer than 48 hours. A heating pad or hot shower or bath can helps relieve muscle tension and pain. Be careful to avoid burns with a heating pad; don't use it while sleeping.

Exercise

Exercise is the most important component for the treatment of chronic low back pain. Experts suggest resting the back in the very early stages, but usually not for more than two days, and then beginning an exercise plan as soon as the pain permits, once the worst is over.

Nice To Know:

What About Bed Rest?

Spending more than a day or two in bed is not recommended. Too much bed rest cause the bones to lose calcium, weakens muscles, and is likely to make your back problem worse.

To strengthen your back after injury - and to help prevent future backaches - try aerobic exercise. Research has shown that low-stress aerobic exercise is an effective form of treatment for back pain.

  • Aerobic exercise releases the body's own natural painkillers, called endorphins.
  • Exercise speeds up back rehabilitation and has been shown to help reduce the risk of future back injuries.
  • In addition, the more fit a person is, the more discomfort he or she can tolerate.

It is important to start any exercise program slowly and to gradually build up the speed and length of time of the exercise. At first, symptoms may worsen as one increases activity. Usually this is nothing to worry about, but if pain becomes severe, contact your physician.

Activities that can be performed without putting much stress on the lower back include:

  • Walking short distances
  • Using a stationary bicycle
  • Water aerobics or swimming

Physical Therapy

Physical therapy offers a wide range of treatments for back problems. Physical therapy treatments have four main goals:

  • Relieve pain
  • Accelerate natural healing processes
  • Increase strength and flexibility of back muscles and ligaments
  • Help prevent future episodes of back pain

Types of treatment used by the physical therapist will depend on the nature of the condition being treated. Some treatments have not been proven scientifically but can still be helpful in certain individuals. These treatments include:

  • Flexibility and strengthening exercise programs. These types of programs are important to keep the low back muscles flexible and strong. They are among the main safeguards to prevent future back injuries. It is important to begin slowly and progress as tolerated, using pain as your guide. The old adage "no pain, no gain" is not the rule of thumb for the recovery of back pain.
  • Heat. Heat usually is applied when there is a small area of tissue damage and inflammation. Electrical currents can be used to relieve pain and also to stimulate circulation in the deeper tissues.
  • Hydrotherapy. Hydrotherapy involves the use of water to treat physical disorders and may include baths, spas, pools, or shower sprays.
  • Electrical nerve stimulation. This includes transcutaneous electrical nerve stimulation (TENS), in which electrodes are placed on the back to gently stimulate nerves and help alleviate pain. TENS appears to be helpful for some people with spinal stenosis, but has not otherwise been found to be generally helpful. An alternative version delivers the electrical stimulation through acupuncture needles. Treatment generally consists of 45-minute treatment periods three times a day. Most people hardly feel the electrical sensation.
  • Tissue mobilization and massage techniques. Massage and a variety of soft tissue mobilization techniques are being used more often by therapists who specialize in manual therapy. These techniques may be helpful to increase circulation to the area, release muscle spasms, and stretch back tissues.
  • Traction. Traction or spinal stretching equipment has been used to help decrease pressure on the nerve roots and provide a stretch to tight muscles of the back. Some experts, however, question the effectiveness of this technique. While once used commonly, traction has now generally fallen out of favor.
  • Back education. This involves teaching proper posture and lifting techniques as part of a total back care program. This information helps people to adapt and adopt the right attitudes toward the body and its functional use.

Spinal Manipulation

This involves manual treatment to apply force to the back to adjust the spine. The aim is to "manipulate" the back, or "realign the spine" in order to restore the range of motion of the back.

Spinal manipulation can be helpful for some people in the first month of low back symptoms. It is unlikely to help those with a disc prolapse and may be unsafe for people who have had:

  • Previous back surgery
  • Back injury from disease affecting the back
  • Malformation of the back

Only a professional with experience in manipulation should do this. This includes chiropractors, osteopaths, and therapists.

With the patient lying on his or her side, the practitioner places one hand on the shoulder and the other on the hip, and applies pressure in opposite directions, thus twisting or rotating the spine. A cracking sound is often heard.

Before having a spinal manipulation, it is important to have a proper medical assessment to be sure there is no serious condition that may be causing the back pain. Manipulations are not generally dangerous, but in people with osteoarthritis, the bony spurs may rarely cause serious complications if the twisting maneuver brings the spurs into contact with and damages the spinal cord or nerves.

Epidural Steroid Injections

Epidural steroid injections involve injecting medication directly into the spine, as a way to reduce swelling and relieve pain. These injections do not work well for everyone with back pain, but they can be helpful for some people in whom other therapies have not been effective but who wish to avoid surgery.

Medication

Medicines for back pain can be purchased over-the-counter (OTC) or are prescribed by a physician. Their purpose is to relieve pain and reduce inflammation.

OTC pain relievers include acetaminophen (Tylenol) and aspirin.

  • Acetaminophen generally is considered safe, although it may pose risks to the kidneys or to the liver in some individuals with liver disease.
  • Aspirin is a popular medicine because of its ability to relieve pain as well as inflammation (swelling, redness). However, aspirin is not suitable for people who have had a stomach ulcer or aspirin allergy. Children should never take aspirin because of the risk for a rare but serious condition called Reye's syndrome.

OTC nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation. There are a wide variety of NSAIDs to choose from, including:

  • Diclofenac (Cataflam, Voltaren)
  • Diflunisal (Dolobid)
  • Etodolac (Lodine)
  • Flurbiprofen (Ansaid)
  • Ibuprofen (Advil, Motrin)
  • Indomethacin (Indocin)
  • Ketoprofen (Actron)
  • Meclofenamate (Meclomen)
  • Nabumetone (Relafen)
  • Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • Orudis, Oruvail
  • Oxaprozin (Daypro)
  • Phenylbutazone
  • Piroxicam (Feldene)
  • Salsalate (Disalcid)
  • Sulindac (Clinoril)
  • Tolmetin (Tolectin)

Unfortunately, NSAIDs have been characterized as having a "double-edged sword," since gastrointestinal (GI) complaints - which range from stomach upset to ulceration and bleeding - are common side effects of these medicines.

  • Such complaints sometimes can be controlled by taking the NSAID with food or by using antacids between meals.
  • However, if GI problems are more than mild or are long-lasting, the physician may prescribe an NSAID that causes fewer GI side effects (for example, salsalate).
  • NSAIDs also can cause kidney damage, worsen blood pressure (with salt and fluid retention), and contribute to bleeding by affecting the platelets (clotting elements in the blood).

NSAID partners may be prescribed by a physician to lessen the side effects of NSAIDs. These include:

  • Antacids
  • Misoprostol (Cytotec)
  • Ranitidine (Zantac)
  • Omeprazole (Prilosec)

COX-2 inhibitors are new medications that reduce pain without causing the ulcer disease and at least partially preventing the GI complaints associated with NSAIDs. These medicines, which are available by prescription only, include:

  • Celecoxib (Celebrex)
  • Rofecoxib (Vioxx)

Nice To Know:

Researchers have discovered two cyclooxygenase ("COX") enzymes within the body:

  • the COX-1 enzyme releases prostaglandins (fatty acid molecules) that help to form a protective coating within the digestive tract, and
  • the COX-2 enzyme releases prostaglandins responsible for pain and inflammation.

Current NSAIDs inhibit both enzymes. Since inhibition of COX-1 leaves the stomach lining vulnerable, NSAIDs may promote side effects such as stomach ulcers and bleeding. By contrast, inhibition of COX-2, while providing pain relief, is less like to cause stomach ulcers or bleeding.

COX-2 inhibitors - a new class of medications - have been developed to manage the pain and inflammation of arthritis without the negative side effects of NSAIDs. Of three products initially approved for use in the United States, only celecoxib (Celebrex®) is currently available by prescription. In 2004, Merck & Co, Inc.voluntarily recalled rofecoxib (Vioxx®) after studies showed it was associated with increased risk of heart attack, stroke, and other cardiovascular events compared to placebo. Another drug, valdecoxib (Bextra®) was withdrawn from the U.S. market by its manufacturer, Pfizer, in 2005. Valdecoxib was withdrawn after it was linked to stroke, heart attack, and serious skin reactions.   Long-term studies of these medications are needed to fully understand their impact upon arthritis patients.

Muscle relaxants sometimes are prescribed for back pain if muscle spasms contribute to a person's discomfort. These include:

  • Cyclobenzaprine (Flexeril)
  • Carisoprodol (Soma)
  • Methocarbamol (Robaxin)

Nice To Know:

Many medicines prescribed for low back pain can make people feel drowsy, especially muscle relaxants. These medicines should not be taken if you need to drive or operate heavy equipment. It is important to discuss with your physician all the benefits and risks of any medicine prescribed. If side effects (such as nausea, vomiting, rash, dizziness) develop, you should discuss other options with your healthcare provider.

 

 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.