Lower Back Pain: causes, symptoms and treatments. TeMed.com

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Low Back Pain treatment
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Definition
If you have lower back pain, you are not alone.
About 80 percent of adults experience low back
pain at some point in their lifetimes. It is the
most common cause of job-related disability and a
leading contributor to missed work days. In a
large survey, more than a quarter of adults
reported experiencing low back pain during the
past 3 months. Men and women are equally affected
by low back pain, which can range in intensity
from a dull, constant ache to a sudden, sharp
sensation that leaves the person incapacitated.
Pain can begin abruptly as a result of an
accident or by lifting something heavy, or it can
develop over time due to age-related changes of
the spine. Sedentary lifestyles also can set the
stage for low back pain, espe- cially when a
weekday routine of getting too little exercise is
punctuated by strenuous weekend workout. Most low
back pain is acute, or short term, and lasts a
few days to a few weeks. It tends to resolve on
its own with self-care and there is no residual
loss of function. The majority of acute low back
pain is mechanical in nature, meaning that there
is a disruption in the way the components of the
back (the spine, muscle, intervertebral discs,
and nerves) ?t together and move. Subacute low
back pain is de?ned as pain that lasts between 4
and 12 weeks. Chronic back pain is de?ned as pain
that persists for 12 weeks or longer, even after
an initial injury or underlying cause of acute
low back pain has been treated. About 20 percent
of people affected by acute low back pain develop
chronic low back pain with persis- tent symptoms
at one year. In some cases, treatment
successfully relieves chronic low back pain, but
in other cases pain persists despite medical and
surgical treatment.
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Short term Low Back Pain treatment
Treatment for lower back pain depends upon the
patient's history and the type and severity of
pain. The vast majority of lower back pain cases
get better within six weeks without surgery, and
lower back pain exercises are almost always part
of a treatment plan. Here are few common methods
to effectively treat Short term Low Back Pain,
also called acute back pain
Rest Ceasing activity for a few days allows
injured tissue and even nerve roots to begin to
heal, which in turn will help relieve lower back
pain. However, more than a few days of rest can
lead to a weakening of the muscles, and weak
muscles have to struggle to adequately support
the spine. Patients who do not regularly exercise
to build strength and ?exibility are more likely
to experience recurrent or prolonged lower back
pain. Painkillers
Paracetamol is effective in treating most cases
of back pain. Some people find non-steroidal
anti-inflammatory drugs (NSAIDs), such
asibuprofen, more effective. A stronger
painkiller, such as codeine, is also an option
and is sometimes taken in addition to
paracetamol. If you also experience muscle spasms
in your back, your GP may recommend a short
course of a muscle relaxant, such as
diazepam. Painkillers can have side effects, some
can be addictive and others may not be suitable,
depending on your state of health. Your GP or a
pharmacist will be able to give you advice about
the most appropriate type of medication for you.
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Short term Low back pain treatment
Hot and cold treatments Some people ?nd that heat
for example, a hot bath or a hot water bottle
placed on the affected area helps ease the
pain. Cold, such as an ice pack or a bag of
frozen vegetables, placed on the painful area is
also effective. Do not put the ice directly on to
your skin because it might cause a cold burn.
Wrap the frozen pack in a wet cloth before
applying it to the affected area. Another option
is to alternate between hot and cold using ice
packs and hot compres- sion packs or a hot water
bottle. Hot compression packs can be bought at
most larger pharmacies. Sleeping
position Changing your sleeping position can take
some of the strain off your back and ease the
pain. If you sleep on your side, draw your legs
up slightly towards your chest and put a pillow
between your legs. If you sleep on your back,
placing a pillow under your knees will help
maintain the normal curve of your lower back.
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Short term Low back pain treatment
Relaxation Trying to relax is a crucial
part of easing the pain because muscle tension
caused by worrying about your condition can make
things worse. Research suggests that people who
manage to stay positive despite the pain tend to
recover quicker and avoid long-term back pain.
Keep moving Most experts now agree that
staying in bed, lying down or being inactive for
long periods is bad for your back. People who
remain active are likely to recover more quickly.
This may be dif?cult at ?rst if the pain is
severe, but try to move around as soon as you can
and aim to do a little more each day. Activity
can range from walking around the house to
walking to the shops. You will have to accept
some discomfort but avoid anything that causes a
lot of pain. There is no need to wait until you
are completely pain-free before returning to
work. Going back to work will help you return to
a normal pattern of activity, and it can often
distract you from the pain. Exercise and
lifestyle Try to address the causes of your back
pain to prevent further episodes. Common causes
include being overweight, poor posture and
stress. Regular exercise and being active on a
daily basis will help keep your back strong and
healthy. Activities such as walking, swimming and
yoga are popular choices. The important thing is
to choose an enjoyable activity that you can
bene?t from without feeling pain.
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Chronic Low Back Pain treatment
If you have had back pain for more than six weeks
(known as chronic back pain), your GP will
probably recommend you the treat- ments listed
below. Exercise Usually take the form of a
group class supervised by a quali?ed instructor.
The classes may include exercises to strengthen
your muscles and improve your posture, as well as
aerobic and stretching exercises. NICE recommend
a maximum of eight sessions over a period of up
to 12 weeks.
Manual therapy There are different types of
manual therapy including manipulation,
mobilisation and massage, usually carried out by
chiropractors, osteopaths or physiotherapists
(chiropractic and osteopathy aren't widely
available on the NHS). NICE recommend a maximum
of nine sessions over a period of up to 12
weeks. Acupuncture An ancient Chinese
treatment where ?ne needles are inserted at
different points in the body. It's been shown to
help reduce lower back pain. NICE recommend that
an acu- puncture course should include a maximum
of 10 sessions over a period of up to 12
weeks. These treatments are often effective for
people whose back pain is seriously affecting
their ability to carry out daily activities and
who feel distressed and need help coping.
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Chronic Low back pain treatment
Antidepressants If the painkillers do not help,
you will probably be prescribed tricyclic
antidepressants (TCAs), such as amitriptyline.
TCAs were originally intended to treat
depression, but they are also effective at
treating some cases of persistent pain. If you
are prescribed a TCA to treat persistent back
pain, the dose is likely to be very small.
Counselling If the treatments described above are
not effective, you may be offered counselling to
help you deal with your condition. While the pain
in your back is very real, how you think and feel
about your condition can make it worse. Cognitive
behavioural therapy (CBT)works by helping you to
manage your back pain better by changing how you
think about your condition. Studies have shown
that people who have had CBT later reported lower
levels of pain. They were also more likely to
remain active and take regular exercise, further
reducing the severity of their symptoms.
Nerve root blocks A nerve root block is
where a steroid or anaesthetic is injected into
your back. If your back pain is caused by a
trapped or inflamed nerve in your spinal column,
the injection can help relieve the pain in your
back, plus any associated leg pain. To be
effective, the injection needs to be made at
exactly the right place in your back, so the
procedure will be carried out under X-ray or CT
guidance. Facet joint injections It is also
possible to have anaesthetic or steroid
injections in the facet joints. The facet joints
are the joints that connect one vertebrae to
another so that your spine is kept aligned. The
joints are sometimes affected by arthritis. Facet
joint injections are not always effective at
relieving back pain.
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Chronic Low back pain treatment
Surgery Surgery for back pain is usually only
recommended when all other treatment options have
failed. Surgery may be recommended if your back
pain is so severe or persistent that you are
unable to sleep or carry out your day-to-day
activities. The type of surgery will depend on
the type of back pain you have and its cause. For
example, a procedure known as a discectomy may be
used if you have a prolapsed disc. The discs are
the circular, spongy tissue between the vertebrae
that help cushion your spine. A prolapsed disc is
where the hard outer membrane of the disc is
damaged, causing the soft, jelly-like ?uid inside
to leak out. A discectomy involves removing the
damaged part of the disc through an incision made
in your back. It is now possible for surgeons to
carry out the procedure using a very small
incision and a microscope or magnifying lenses to
?nd the damaged disc. This minimizes the amount
of trauma to the surrounding tissue, reduces the
pain and discomfort in the affected area and
results in a smaller scar. Spinal fusion surgery
is a less common surgical procedure where the
joint that is causing pain is fused to prevent it
moving. As bone is living tissue, it is possible
to join two or more vertebrae together by placing
an additional section of bone in the space
between them. This prevents the damaged vertebrae
irritating or compressing nearby nerves, muscles
and ligaments, and reduces the symptoms of
pain. Spinal fusion is a complicated procedure
and the results are not always satisfactory. For
example, you may still experience some degree of
pain and loss of movement following surgery.
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Prevention

• There are many ways to prevent lower back pain.
  Learning prevention techniques can also help
  lessen the extent of your symptoms if a lower
  back injury should occur. Prevention management
  includes
• Strengthening your abdominal and back muscles
• Reducing stress on your lower back by
  controlling your weight
• Practicing safe lifting and carrying techniques
  Lift objects correctly by keeping your back
  straight, bending your knees and lifting with
  your legs.
• Maintaining good posture when youre sitting and
  when standing Sleeping on a supportive surface
• Sitting on chairs that are supportive and allow
  your feet to rest ?at on the ?oor
• Avoiding wearing shoes with high heels
• Trying to stop smoking nicotine impairs blood
  ?ow and also leads to disc degeneration.
• Standing
• If you need to stand up in the same place for an
  extended period, try resting one foot on a small
  stool or step.
• While standing in the of?ce or the kitchen, open
  the door of a cabinet and rest one foot inside
  the cabinet. Alternate feet every 5 to 10
  minutes.
• Practice good posture when standing by holding
  your head up. Keep your shoulders straight and
  your chest forward. Your weight should be evenly
  balanced on both your feet and your hips should
  be tucked in.

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Prevention

• Sitting
• It is vital that your chair provide adequate
  support for your lower back. The chair should be
  curved where the small of your back meets the
  seat to provide support for your spine.
• Use a small foot stool or foot rest to keep your
  knees slightly higher than your hips.
• If you need to turn while youre sitting, avoid
  twisting at the waist. Instead, rotate your whole
  body when you turn.
• Sleeping
• Avoid sleeping ?at on your back. Lie on your side
  with your knees bent. Try placing a pillow
  between your knees.
• Try to avoid sleeping on your stomach.

• Lifting
• Before attempting to lift something heavy,
  make sure you have secure footing. Lower your
  body to the level of the object by bending your
  knees. Keep your low back straight. Never bend
  over from the waist. Tighten your abdominal
  muscles and lift, using your leg muscles. Use a
  smooth, consistent motion without jerking.
• When you lift an object off a table or
  counter, ?rst slide it to the edge. This will
  enable you to hold it closer to your body. Keep
  your back straight and bend your knees. Lift with
  your legs and return to a standing position.
• Never lift or carry objects above the level
  of your waist. Hold objects near your body and
  keep your arms bent.

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