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.
Looking At Two Kinds Of Back Pain
Lets talk about the most common forms of back pain: acute and subacute . Most of these cases are due to harmless causes. We lump them into the mechanical back pain diagnosis, which includes muscle spasm, ligament strain, and arthritis. A handful will be due to potentially more serious causes such as herniated discs , spondylolisthesis , a compression fracture of the vertebra due to osteoporosis , or spinal stenosis . Rarely, less than 1% of the time, we will see pain due to inflammation , cancer , or infection.
When someone with acute low back pain comes into the office, my main job is to rule out one of these potentially more serious conditions through my interview and exam. It is only when we suspect a cause other than mechanical that we will then order imaging or labs, and then things can go in a different direction.
But most of the time, were dealing with a relatively benign and yet really painful, disabling, and expensive condition. How do we treat this? The sheer number of treatments is dizzying, but truly effective treatment options are few.
Taming The Pain Of Sciatica: For Most People Time Heals And Less Is More
- By Steven J. Atlas, MD, MPH, Contributor
Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most is a bulging disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.
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What Is The Outlook For Adult Scoliosis
The outlook for adult scoliosis can vary depending on the type and severity of symptoms. Non-operative treatment, with modalities such as physical therapy, a regular exercise program, and over the counter anti-inflammatory medications is always the first line of care. Maintaining an ideal body weight and maintaining a regular exercise program are excellent ways to minimize symptoms associated with adult scoliosis.
Surgical treatment of adult scoliosis can improve a patients quality of life and deal with pain connected to the condition. The results of adult spinal deformity surgery are typically very good, if done well and for the right reasons. With that said, the surgeries are associated with significant risk, and should be avoided if at all possible.
Last reviewed by a Cleveland Clinic medical professional on 09/25/2019.
References
How Are Back Strains And Sprains Treated
The treatment for strains and sprains is similar, and often takes place in two phases.
The goal of the first phase is to reduce the pain and spasm. This may involve rest, and the use of ice packs and compression , especially for the first 24 to 48 hours after the injury. An over-the-counter nonsteroidal anti-inflammatory drug, such as ibuprofen , may be recommended to help reduce pain and swelling.
After the first 24 to 48 hours, returning to normal activities, as tolerated, is advisable. Extended bed rest or immobility simply prolongs symptoms and delays recovery.
Most people with lumbar strain/sprain symptoms improve in about 2 weeks. If symptoms continue for more than 2 weeks, additional treatment may be required.
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How Is Low Back Pain Diagnosed
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Tests include:
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
How Common Is Lower Back Pain
Around four out of five people have lower back pain at some point in their lives. Its one of the most common reasons people visit healthcare providers.
Some people are more likely to have lower back pain than others. Risk factors for lower back pain include:
- Age: People over 30 have more back pain. Disks wear away with age. As the disks weaken and wear down, pain and stiffness can result.
- Weight: People who are obese or carry extra weight are more likely to have back pain. Excess weight puts pressure on joints and disks.
- Overall health: Weakened abdominal muscles cant support the spine, which can lead to back strains and sprains. People who smoke, drink alcohol excessively or live a sedentary lifestyle have a higher risk of back pain.
- Occupation and lifestyle: Jobs and activities that require heavy lifting or bending can increase the risk of a back injury.
- Structural problems: Severe back pain can result from conditions, such as scoliosis, that change spine alignment.
- Disease: People who have a family history of osteoarthritis, certain types of cancer and other disease have a higher risk of low back pain.
- Mental health: Back pain can result from depression and anxiety.
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Find A Physical Therapist
This can make a big difference, especially if youâve had the pain for more than 4-6 weeks. With techniques like electrical stimulation, ultrasound, heat, and muscle relaxation, these specialists help you get more mobile and flexible.
They can also teach you exercises to do on your own to keep your symptoms from coming back. These can help your posture and keep your back and abdominal muscles healthy.
How To Know If The Back Pain Is Muscular Or Discal
Your doctor may perform a neurological exam to check muscle strength, reflexes, the ability to walk, and the ability to feel touch. Imaging tests may be ordered to diagnose the cause of your pain. A CT scan shows cross-sectional images of the spine and can identify a herniated disc.
How to know if back pain is muscular?
Symptoms that can be expected from a pulled lower back muscle or any type of tension in the lower back usually include: dull, aching lower back pain. Tight muscles are usually sore, tense, or sore. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle.
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When Are Diagnostic Tests For Lower Back Pain Necessary
Many patients do not need X-rays in the first few weeks of pain because their pain will end up resolving. Many more do not need CT scans or MRI imaging, which are overly sensitive and often reveal abnormalities not related to the patients pain. These forms of imaging can be extremely useful, however, if a person has chronic or severe pain, and/or neurological symptoms. Blood tests may be ordered if an infection or tumor is suspected.
Is The Weight Of Pregnancy The Reason Why So Many Pregnant Women Get Sciatica
Its true that sciatica is common in pregnancy but increased weight is not the main reason why pregnant women get sciatica. A better explanation is that certain hormones of pregnancy cause a loosening of their ligaments. Ligaments hold the vertebrae together, protect the disks and keep the spine stable. Loosened ligaments can cause the spine to become unstable and might cause disks to slip, which leads to nerves being pinched and the development of sciatica. The babys weight and position can also add pressure to the nerve.
The good news is there are ways to ease sciatic pain during pregnancy, and the pain goes away after birth. Physical therapy and massage therapy, warm showers, heat, medications and other measures can help. If you are pregnant, be sure to follow good posture techniques during pregnancy to also ease your pain.
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Finding A Position Of Comfort
For immediate relief, finding a position of comfort or applying pressure is helpful. You can try lying face down, applying ice to the affected area, or alternatively, getting a gentle massage. It can also be helpful to practice some stretching exercises to help relax your muscles. Yoga, in particular, can be helpful. However, do remember to stop immediately if you feel sharp or increased pain.
What Causes Back Pain
Back pains can have numerous reasons. But often no specific cause can be tracked, and the pain will stop. There can be two types of back pains: Chronic and acute. If the pain in the back is present for less than a month, then the pain is acute. And if the pain has been there for a more extended period, then the pain is chronic. Chronic illnesses are often less common than acute pains and last more than three months.
The pain can be caused by injuries such as a fracture, muscle strain or ruptured disk. Medical conditions such as skeletal irregularities, osteoporosis, arthritis, etc. can also be a reason for back pain but are more on the severe side.
The most common causes of back pain can be a persons age, excess weight, lack of exercise, diseases, smoking, psychological conditions, improper lifting, etc.
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How Are They Diagnosed
Since AAAs dont usually cause symptoms, healthcare providers often diagnose unruptured AAAs when theyre performing exams or tests for other health conditions. The following imaging exams may reveal an AAA:
- Abdominal ultrasound: An ultrasound is a quick, painless test that uses sound waves to create real-time images of the inside of your belly. Your healthcare provider may be able to see an aneurysm on an abdominal ultrasound.
- Computed tomography angiography : Your healthcare provider may do a CTA if they see an aneurysm on your ultrasound. You receive an injection of a contrast dye before a CT scan. Angiography helps your provider see the exact location, size and severity of the aneurysm.
How Is Sciatica Treated
The goal of treatment is to decrease your pain and increase your mobility. Depending on the cause, many cases of sciatica go away over time with some simple self-care treatments.
Self-care treatments include:
- Appling ice and/or hot packs: First, use ice packs to reduce pain and swelling. Apply ice packs or bag of frozen vegetables wrapped in a towel to the affected area. Apply for 20 minutes, several times a day. Switch to a hot pack or a heating pad after the first several days. Apply for 20 minutes at a time. If youre still in pain, switch between hot and cold packs whichever best relieves your discomfort.
- Taking over-the-counter medicines: Take medicines to reduce pain, inflammation and swelling. The many common over-the-counter medicines in this category, called non-steroidal anti-inflammatory drugs , include aspirin, ibuprofen and naproxen . Be watchful if you choose to take aspirin. Aspirin can cause ulcers and bleeding in some people. If youre unable to take NSAIDS, acetaminophen may be taken instead.
- Performing gentle stretches: Learn proper stretches from an instructor with experience with low back pain. Work up to other general strengthening, core muscle strengthening and aerobic exercises.
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How Long Does Lower Back Pain Last & What To Do For It
Lower back pain is a condition that affects so many people. It is estimated that about 80% of adults do suffer from lower back pain at some point of their lifetime. This problem is a work related disability and a major cause of absenteeism in most working places. Lower back pain affects both genders and can be felt in different intensities ranging from dull persistent pains to sharp pains that can immobilize a person.
Factors like accident, age, lifting of heavy materials and sedentary lifestyles can cause lower back pains. However, a bigger percentage of low back pain is termed as mechanical and is linked to Spondylosis which is the general degeneration of the spine in connection to wear and tear in bones, discs and joints as you grow old.
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Is It A Pinched Nerve Or Pulled Muscle In The Lower Back
A pulled muscle occurs when you tear or overstretch some of the muscle fibers. This can happen if you overwork the muscle or twist it too hard. You will probably notice pain and swelling, and the area will be tender to the touch. You may even notice redness or bruising.
A pinched nerve, or nerve compression, happens when pressure in an area causes the nerve impulses to become partially blocked. You may experience a radiating, burning pain in the affected area.
While a pulled muscle in your lower back could potentially cause a pinched nerve, this can also be caused by a herniated disc in your spine. If you feel radiant pain that extends into your legs, see a doctor right away.
How To Manage Sciatic Pain
For many people, sciatica responds well to self-care. Rest for a couple of days after a flare-up begins, but dont wait too long before resuming activity. Long periods of inactivity will actually make your symptoms worse.
Applying hot or cold packs to your lower back may provide temporary relief. You can also try these six stretches to help relieve sciatic pain.
Over-the-counter medication, like aspirin or ibuprofen , may help reduce inflammation, swelling, and alleviate some of your pain.
If your symptoms are severe and home remedies arent reducing your pain, or if your pain is getting worse, see your doctor. They might prescribe medications to relieve your symptoms, such as:
- anti-inflammatories
- antiseizure medications
- narcotics in severe cases
Your doctor may also suggest that you attend physical therapy after your symptoms improve. Physical therapy can help prevent future flare-ups by strengthening your core and back muscles.
You doctor might also suggest steroid injections. When injected into the area surrounding the affected nerve, steroids can reduce inflammation and pressure on the nerve. You can only receive a limited number of steroid injections, though, since theres a risk of severe side effects.
Surgery may be recommended as a last resort if your pain hasnt responded to other treatments. It may also be an option if your sciatica is causing loss of bowel or bladder control.
There are some things you can do to prevent future sciatica flare-ups:
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What Happens At Your Gp Appointment
If you have symptoms of spondylolisthesis, the GP may examine your back.
They may also ask you to lie down and raise 1 leg straight up in the air. This is painful if you have tight hamstrings or sciatica caused by spondylolisthesis.
The GP may arrange an X-ray to see if a bone in your spine has slipped forward.
You may have other scans, such as an MRI scan, if you have pain, numbness or weakness in your legs.
What Are The Symptoms Of Adult Scoliosis
Most cases of adult scoliosis dont cause symptoms, though pain may develop. Back pain occurs for many reasons including arthritis, inability to stand upright, and/or due to weakness of the core musculature and loss of conditioning. Leg pain/numbness/weakness may develop if there is pressure on the nerves in the lumbar spine.
In some cases, changes in the body may include:
- Height loss
- Uneven alignment of the pelvis and hips
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