How Do So Many Health Care Professionals Go Wrong When They Treat Low Back Pain
Why does the myth of mechanical back pain, the premise for so much ineffective treatment, get repeated endlessly on the Internet and in health care offices around the world?
Plus, of course, there are an almost unbelievable number of sketchier treatments for sale, easily marketed to desperate souls. Is low back pain treatment really this much of a mess? Sadly, I believe so.14 I clearly remember graduating clueless myself. If I hadnt spent many years doing post-grad study of low back pain, I wouldnt know 98% of whats in this tutorial.
Yes, stress is a factor in low back pain, but meditation & yoga are over-rated & inappropriate options for many people. This tutorial explores more practical options.
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How I Recovered From 3 Years Of Chronic Back Pain
Im very grateful to say that Ive been pain-free for six months and have returned to long-distance running.
Id like to share what worked for meespecially since so many things did not work, and I know what a frustrating problem this can be, with little hope. I see the updates of friends and colleagues who suffer just as I did.
Ill first offer some context on my particular history, but if youd rather just go straight to the solutions, scroll down to the heading What Worked to Eliminate My Back Pain.
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Dont Shortchange Your Sleep
Sleep is very, very important it helps your body heal, says Dr. Welches. Lack of sleep releases more stress hormones, lowers pain tolerance and worsens existing pain.
Sleep loss can complicate other health issues, making it harder to control glucose levels when you have diabetes, for example.
So practice good sleep hygiene. Avoid blue light from smart phones or TV for one hour before bedtime. Go to bed at about the same time every evening and get up at about the same time every morning to keep your internal clock regular, says Dr. Welches.
Meditation is also a great tool for a better nights sleep. Many meditation apps are available. He suggests starting with five to 10 minutes of meditation before bedtime. If you wish, you can gradually increase to 20 or 30 minutes a night.
Supplements such as melatonin can also help you sleep at night.
Yoga Pilates And Tai Chi Seem To Help But Its Not Clear That Theyre Any Better Than Other Exercise
Theres lots of research on back pain and yoga. Not all of it is high-quality, but taken together, the evidence pretty uniformly suggests yoga can both decrease pain and improve back-related function.
The most recent Cochrane systematic review on yoga and chronic low back pain, published in 2017, sums up the results of the best available studies, which mostly focused on the Iyengar, Hatha, or Viniyoga forms of yoga:
There is low- to moderate-certainty evidence that yoga compared to non-exercise controls results in small to moderate improvements in back-related function at three and six months. Yoga may also be slightly more effective for pain at three and six months, however the effect size did not meet predefined levels of minimum clinical importance.
So again, this isnt an end-all treatment but the evidence we have points in the direction of a benefit.
Importantly, the review authors also noted that its not clear whether yoga is better than other exercises, since there were few head-to-head comparisons tracking yoga against other kinds of workouts.
For Pilates, the evidence was a little more mixed: It was associated with small or no effects on pain and no effects on function compared with other types of exercise. Again, though, pretty much every back expert I spoke to said any exercise is better than no exercise, so if Pilates is something you enjoy, do it.
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Heres What The Study Couldnt Tell Us
The study was missing a few potentially helpful low-risk medicines. Topicals such as the lidocaine patch or capsaicin ointment were not included, which is a shame, as these can provide relief for some people, and carry little risk. I would also be interested to know if over-the-counter topical therapies containing menthol and camphor are better than placebo for low back pain. Suggestions for the future research, and the next update!
I plan to write about chronic low back pain in a future post, because there was a guideline update for that specific issue as well.
Chronic Back Muscle Pain Diagnosis
Patients who are diagnosed with chronic muscular back ache are quite lucky compared to patients who are diagnosed with some underlying structural source of spinal joint pain. However, achieving this diagnosis is a rare event. Chronic muscle aches and pains confound back doctors and are typically grossly mismanaged by the medical professions. Muscle imbalances are sometimes theorized, although this in vogue diagnosis often amounts to little more than smoke and mirrors.
Fibromyalgia is sometimes pronounced, but the medical treatment of this condition remains among the worst and most ineffectual in the entire healthcare field.
Muscle imbalances are also sometimes thought to cause ongoing symptomatic conditions in the soft tissues of the back and neck.
Sometimes, the doctor just does not know what is wrong and this can be a real blessing in disguise. At least the symptoms will not be mistakenly attributed to some innocent irregularity in the spine, as is the rule rather than the exception.
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How Is Back Pain Treated
Acute back pain usually gets better on its own. Acute back pain is usually treated with:
- Medications designed to relieve pain and/or inflammation
- analgesics such as acetaminophen and aspirin
- non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen may be sold over the counter some NSAIDS are prescribed by a physician
- muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles
- topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
Exercising, bed rest, and surgery are typically not recommended for acute back pain.Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.
Back Pain: How To Live With One Of The Worlds Biggest Health Problems
The most common cause of disability is a condition as old as time itself. But is the industry that has built up around scans, injections and opioids a waste of time?
My alarm went off one morning about 18 months ago and I woke up to realise I was in agony. It was my back. I tried moving, I tried lying still, I tried sitting: everything hurt. I visited a physiotherapist recommended by a friend. I do not remember what she said, but I felt listened to. Over the next days and weeks, the pain lessened, but I was still terrified to move. It was most intense just above my left hip, but it had infused my whole being, taken my energy, taken any pleasure I had in life. It was exhausting, being in pain or worrying about being in pain. I felt very low. I went from exercising four times a week to doing none at all. I wanted it to get better straight away, so that I could get back to my old life. There is something about back pain that makes you desperate to find a magical solution. Bearing the pain, waiting for it to get better, is unthinkable.
This month, the Lancet published a series of three papers written by a large, international group of experts who came together to raise awareness of the extent of the problem of low back pain and the evidence for recommended treatments. The authors were scathing about the widespread use of inappropriate tests and unnecessary, ineffective and harmful treatments.
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Fact: There’s Rarely A Single Treatment That Will Cure Chronic Pain
“People with chronic pain often have this misconception,” Savage says. “They think that they’ll be able to find this one perfect treatment that will cure their pain.”
Maybe it’s a new drug or a new surgical technique that they read about in the paper. Or maybe it’s a device or a supplement they see advertised on a 3 a.m. infomercial. But they’re hoping that there’s one answer for them that will take their pain away completely.
Coping with chronic pain is rarely that simple. Savage says that tackling chronic pain often requires a team of experts using a combination of approaches — different medications, physical therapy, psychological counseling, relaxation techniques, and more — to get it the pain control.
Adopt realistic expectations. You will get better, but it will take some hard work, different treatments, and time.
Bulging Discs Cause A Majority Of My Back Pain
Many have been told their pain is coming from disc bulges or tears that look abnormal on their MRIs. Research shows that chronic back pain frequently does not correlate with the structural abnormalities that may appear on MRIs. Many people with disc degeneration, tears, and bulging discs are able to lead pain-free and active lives.
Disc degeneration is a normal process. In fact, the blood supply to our discs was the best when we were teenagers. Every year afterward, the blood supply to the disc decreases. By the time we turn 40, many of us without back pain will have radiographic evidence of disc degeneration.
This process is completely normal. Our spines have the ability to adapt to new environments and activities. Studies have shown the disc actually benefits from increased physical loading and gradually adapts as joints, bones, muscles, tendons, and ligaments do.
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Talk To Your Neurosurgeon
Neurosurgeons are specialists with many years of experience in treating chronic back pain through surgical procedures. When conservative back pain solutions Plano TX fails to provide relief, a neurosurgeon advises patients to undergo surgery.
Here at MINT, our neurosurgeons perform minimally invasive surgery, an advanced procedure that has many benefits. These include less blood loss during the surgery, fewer scars, shorter hospital stays, and faster rehabilitation. Can chronic back pain be cured with minimally invasive surgery contact MINT today to schedule your appointment with our experienced and qualified neurosurgeon!
Drugs Are Not Part Of The Latest Recommendations For Treating Mechanical Back Pain
What the researchers found was surprising: for acute and subacute low back pain, the best and safest treatments are not medicines. The ACP made the following strong recommendation:
Most patients with acute or subacute low back pain improve over time regardless of treatment and can avoid potentially harmful and costly treatments and tests. First-line therapy should include nondrug therapy, such as superficial heat, massage, acupuncture, or spinal manipulation. When nondrug therapy fails, consider NSAIDs or skeletal muscle relaxants.
Because most mechanical back pain improves no matter what, we dont want to prescribe treatment that can cause harm. Because some medications carry significant risks, we really shouldnt be recommending these right off the bat. Rather, we should be providing guidance on heating pad or hot water bottle use, and recommendations or referrals to acupuncturists, massage therapists, and chiropractors. These therapies were somewhat effective, and are very unlikely to cause harm.
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Acupuncture Seems To Help Too Sort Of Though Its More Controversial
One of the oldest approaches to back pain is acupuncture, a core part of traditional Chinese medicine. The philosophical underpinning of acupuncture is that disease or pain in the body is the result of imbalances between the bodys yin and yang forces. Vital energy circulates throughout the body along the so-called meridians, which have either Yin or Yang characteristics, the Cochrane authors explain. Using needles to stimulate the parts of the body that are located on these meridians can modulate pain or reverse disease, practitioners claim.
A 2005 Cochrane review looked at the evidence for acupuncture and low back pain and came to a few useful conclusions: There was insufficient evidence to make any recommendations about acupuncture for acute low back pain so it may or may not help people. For chronic pain, acupuncture seemed to offer more pain relief when compared with no treatment or sham acupuncture . The needling also improved function in the short-term when compared with no treatment for chronic pain sufferers. But acupuncture was not more effective than other treatments.
UpToDate looked at more recent research and noted that the studies on acute pain were still limited, and that evidence for acupunctures effects on chronic pain is somewhat conflicting. The review also noted it was unclear whether acupunctures benefit lies in the needling, or in the placebo effect.
What Is Active Physical Therapy
Active physical therapy involves movement-based activities like: stretching, range of motion exercises, and targeted spine strengthening and conditioning exercises.
The movements and exercises are designed to address those underlying causes of chronic back pain so you can strengthen your back, condition your muscles and improve your mobility.
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Take Action For Back Pain Relief
The excellent news is that for most of us, chronic back pain neednt derail our lives. CBT is available at many pain clinics, as is mindfulness training.
You might also try on your own. You could explore CBT using the book on which the University of Washington class was based: The Pain Survival Guide: How to Reclaim Your Life. Alternatively, you can try mindfulness practice by following recorded instructions. While there are many resources for these, you can listen for free to some that I recorded at mindfulness-solution.com.
Additionally, for a comprehensive guide to using mindfulness along with rehabilitation to work through chronic back pain, you can consult a book I co-authored on the subject: Back Sense: A Revolutionary Guide to Halting the Cycle of Chronic Back Pain.
Were Learning How Much Back Pain Is Mental And That Mind
So where does physical therapy usually a combination of guided exercises, mobilization, superficial heat or cold, and health advice fit into the back pain treatment picture?
In AHRQs read of the evidence, it didnt seem to work better than simple advice to remain active when it came to reducing pain and improving function.
Nowadays, though, there are also several different kinds of physical therapies that also integrate psychotherapy or cognitive behavioral therapy, often called multidisciplinary rehabilitation.
Multidisciplinary rehab takes the biopsychosocial view of back pain again, that the pain arises from the interplay of physical, psychological, and social factors. It can of course be tricky to disentangle whether mood disorders like anxiety or depression contribute to peoples pain, or whether they arise out of the pain, but either way, the biopsychosocial model views the physical as only one part of the equation. So these practitioners deal with whats going on inside the head as part of their back pain therapy helping patients get treatment for their depression or anxiety, or guiding them through cognitive behavioral therapy to improve their coping skills.
Perhaps not surprisingly, multidisciplinary therapy appears to work slightly better than physical therapy alone for chronic back pain in both the short and long term. Patients who get these more holistic treatments are also more likely to return to work.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
What Are Chronic Back Pain Symptoms
Chronic back pain symptoms typically come on gradually and are long-lasting, sticking around for more than six weeks. As we mentioned, chronic pain usually isnt caused by a specific event or injury nor does it just go away or heal itself without medical treatment.
This is different from acute back pain, which usually comes on suddenly and goes away within two to six weeks. And because chronic pain is long-lasting, it often causes you to avoid physical activity or compensate in other ways, which can actually make your pain worse in the long-run.
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