Low Back Pain:
Treatment of low back pain is a challenging problem that just about everyone will have to manage at some point in their life. Most often, back pain resolves with simple treatments. There are a number of options available, and no single treatment has been shown to be superior for the treatment of typical low back pain. These are some of the standard treatments used for back pain, and how they have been shown to be effective.
The first step in the treatment of low back pain is to avoid aggravation of the the back. Patients need to understand that back pain is common, and most often resolves with time. Bed rest was often recommended, but has been found more recently to slow recovery from back pain. Prolonged bed rest can actually lead to more persistent back pain, and studies have shown a faster recovery with gentle physical activity.
Ice and heat application have been often recommended, and provide symptom relief while performing these activities, but there is no known benefit beyond short-term symptom relief.
Anti-inflammatory medications are the most commonly recommended medication for back pain, and have been shown to be one of the most effective medications. Nonsteroidal anti-inflammatory medications (or NSAIDs) work by relieving pain and reducing inflammation. No single medication has been shown to be better than another, and many patients will find one that works best for them (some prefer a once-daily medication, others prefer a medication that can be taken more frequently).
Pain Relieving Medications:
Medications to relieve painful symptoms often help with symptoms that are not relieved by NSAIDs. Often, combining NSAIDs with acetaminophen or Tramadol can help allow for sufficient pain relief, without having to resort to narcotic pain medications. Topical medications, including capsaicin and lidocaine, can also provide relief, although the effects do not last after the medication is removed.
If these are not sufficient, your doctor may consider a short course of a narcotic pain medication. Because of their addictive potential, narcotics are generally used only if other treatments fail to control your symptoms.
Muscle spasm is a common complaint, especially in the early stages of low back pain. In fact, for many patients, the muscle spasm is the most debilitating aspect of low back pain. Relief with muscle-relaxing medications can be helpful in these early stages, but these medications should generally be used for only a short duration. Muscle-relaxing medications have side effects that include drowsiness and dependence.
Steroid medications are effective at decreasing inflammation and can be administered either orally or injected around the spine, a so-called epidural injection. For most common types of back pain, steroid medications have not been shown to be beneficial. Patients who have a pinched nerve, causing symptoms of leg pain, often improve with steroid medications, but typical back pain does not usually require steroid medications. Furthermore, many physicians feel the potential for side-effects with steroid medications does not make them worthwhile.
Physical therapy and exercises have been shown to be most effective in the treatment of chronic low back pain. Exercise can have benefits including improved posture, flexibility and strength. In addition, people who exercise for treatment of back pain have improved mood, lower need for pain medications, and prevention of deconditioning (loss of strength).
A physical therapist can be especially helpful by guiding you in this process, and helping to determine exercises that can be tolerated. Furthermore, an experienced therapist can ensure you perform exercises appropriately so as not to expose you to further injury.
There are a number of alternative treatments for back pain that can often be as or more effective than these traditional treatments. Acupuncture is a Chinese medical therapy used for more than 2,000 years. Massage and chiropractic treatments are also treatment options for back pain.
Many people feel doctors are not receptive to alternative treatments, but the fact is that just as some patients find relief with traditional treatment, many find relief with alternative therapies. I always encourage patients with back pain to talk to me about different treatment options to try and determine what works for them.
Most often, back pain will improve with time and treatments described above. However, some patients ultimately end up needing a surgery to improve from their condition. There are a number of options for surgical treatment of back problems. While most often these steps are not needed, in some patients, spine surgery may be a useful treatment option.
Shen FH, et al. "Nonsurgical Management of Acute and Chronic Low Back Pain" J. Am. Acad. Orthop. Surg., August 2006; 14: 477 - 487.